bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early childhood environment related to microbial exposure and the occurrence of atopic disease at school age
Authors: de Meer G. , Janssen N. A. H. , Brunekreef B. 
Published: April 2005

Background:  There is a growing body of evidence that the early childhood environment with respect to day care attendance, older siblings, pet ownership, and early life airway infections may protect from developing atopic disease. Few studies have distinguished between atopic sensitization and symptoms, and none have evaluated independent contributions for all of these different environmental conditions.Objective:  Examine independent effects on atopic sensitization and symptoms of day care attendance, older siblings, pet ownership, and early infancy's airway disease.Methods:  A cross‐sectional survey among 8–13‐year‐old school children with complete data for 1555 children.Results:  After adjustment for confounders, atopic sensitization occurred less frequently in children that had attended a day care centre (OR: 0.73, 95% CI: 0.55–0.98) or had a cat or dog before 2 years of age (OR: 0.78, 95% CI: 0.61–0.99). Having older siblings yielded a nonsignificant trend towards protection (OR: 0.88, 95% CI: 0.70–1.11). For symptoms, there was no relation with having older sibs, day care attendance and pet ownership, although there was a trend towards protection for the combination of atopy and symptoms. In contrast, children with doctors’ treated airway disease before age 2, more frequently reported recent symptoms of wheeze, asthma, rhinitis, or dermatitis (all P < 0.05).Conclusion:  Early life environmental exposure to day care, or pets may protect against atopic sensitization. Protection against symptoms only occurred if atopic sensitization was present as well.
Bacterial and fungal components in house dust of farm children, Rudolf Steiner school children and reference children – the PARSIFAL Study
Authors: Schram D. , Doekes G. , Boeve M. , Douwes J. , Riedler J. , Üblagger E. , von Mutius E. , Budde J. , Pershagen G. , Nyberg F. , Alm J. , Braun‐Fahrländer C. , Waser M. , Brunekreef B. ,   on behalf of the PARSIFAL Study Group
Published: April 2005

Background:  Growing up on a farm and an anthroposophic lifestyle are associated with a lower prevalence of allergic diseases in childhood. It has been suggested that the enhanced exposure to endotoxin is an important protective factor of farm environments. Little is known about exposure to other microbial components on farms and exposure in anthroposophic families.Objective:  To assess the levels and determinants of bacterial endotoxin, mould β(1,3)‐glucans and fungal extracellular polysaccharides (EPS) in house dust of farm children, Steiner school children and reference children.Methods:  Mattress and living room dust was collected in the homes of 229 farm children, 122 Steiner children and 60 and 67 of their respective reference children in five European countries. Stable dust was collected as well. All samples were analysed in one central laboratory. Determinants were assessed by questionnaire.Results:  Levels of endotoxin, EPS and glucans per gram of house dust in farm homes were 1.2‐ to 3.2‐fold higher than levels in reference homes. For Steiner children, 1.1‐ to 1.6‐fold higher levels were observed compared with their reference children. These differences were consistently found across countries, although mean levels varied considerably. Differences between groups and between countries were also significant after adjustment for home and family characteristics.Conclusion:  Farm children are not only consistently exposed to higher levels of endotoxin, but also to higher levels of mould components. Steiner school children may also be exposed to higher levels of microbial agents, but differences with reference children are much less pronounced than for farm children. Further analyses are, however, required to assess the association between exposure to these various microbial agents and allergic and airway diseases in the PARSIFAL population.
Comparison of nasal immunohistology in patients with seasonal rhinoconjunctivitis treated with topical steroids or specific allergen immunotherapy
Authors: Rak S. , Heinrich C. , Scheynius A. 
Published: April 2005

Background:  Specific allergen immunotherapy (SIT) and nasal steroids (NS) are considered effective anti‐inflammatory treatments for allergic rhinitis, although their mechanism of action differs.Objective:  The aim of this study was to examine the effect of treatment with NS and SIT on different populations of inflammatory cells in the nasal mucosa and to compare cell numbers before and during the birch pollen season in patients with seasonal allergic rhinitis.Methods:  In a randomized, double‐blind, double dummy comparative study, 41 patients with seasonal rhinoconjunctivitis were treated with birch SIT or NS (budesonide 400 μg daily). Treatment with NS started before the birch pollen season and at the same time SIT‐treated patients reached the maintenance dose. Nasal biopsies for immunohistochemistry were obtained before the season and start of the treatments and at the peak of the pollen season during treatment.Results:  Symptoms of rhinoconjunctivitis increased significantly in both groups during the pollen season but less in the NS‐treated group and the difference between the treatment groups was significant at the end of the season (P = 0.03). Immunohistochemistry of nasal biopsies from NS‐treated patients showed significantly fewer CD1a+, IgE+ and FcɛRI+ cells during the season compared with preseason (P = 0.02, P = 0.001 and P = 0.0004, respectively) and with seasonal values of the SIT‐treated group (P = 0.002, P = 0.002 and P = 0.0004 respectively).Conclusion:  Treatment with NS but not SIT decreased the numbers of CD1a+, IgE+ and FcɛRI+ cells during the birch pollen season. Our data indicate that treatment with NS has a broader anti‐inflammatory range than SIT.
Low levels of CC16 in nasal fluid of children with birch pollen‐induced rhinitis
Authors: Johansson S. , Keen C. , Ståhl A. , Wennergren G. , Benson M. 
Published: April 2005

Background:  Clara cell protein 16 (CC16; secretoglobin 1A1) is an anti‐inflammatory protein mainly expressed in the epithelial cells in the airways.Objective:  To compare the levels of CC16 in nasal lavage (NAL) from children with intermittent allergic rhinitis and healthy controls and to study the effect of a local steroid.Methods:  Thirty schoolchildren with birch pollen allergy and 30 healthy controls from the same schools were included in the study. The NAL fluid was collected before the season, during the birch pollen season and, for the patients, after 1 week of treatment with a local steroid. Symptom scores were obtained on every occasion. CC16 and eosinophil cationic protein (ECP) were analyzed with enzyme‐linked immunosorbent assay.Results:  The nasal fluid levels of CC16 were significantly lower in patients than in controls, before and during pollen season. Before the season, the median CC16 concentrations were 9.1 (range 1.1–117) μg/l in patients and 25.7 (6.1–110.2) μg/l in controls. During the season, the median CC16 concentrations in nasal fluid were 12.9 (2.3–89.7) μg/l in the allergic children and 22.0 (9.5–90.1) μg/l in the healthy controls (P = 0.0005). Symptom scores, nasal fluid eosinophils and ECP were higher in patients during the season. Treatment with a local steroid did not change the CC16 levels.Conclusions:  Nasal fluid CC16 levels were lower in children with birch pollen‐induced allergic rhinitis than in healthy controls both before and during the pollen season. We speculate that reduction in anti‐inflammatory activity by CC16 may contribute to the pathogenesis of allergic rhinitis.
Epidemiology of necrotizing enterocolitis – Part I: Changing regional trends in extremely preterm infants over 14 years
Authors: Luig Melissa , Lui Kei ,   NSW & ACT NICUS Group
Published: April 2005

Objectives:  Advances in perinatal care include exogenous surfactant, unequivocal acceptance of antenatal steroids and in utero and ex utero transfers to tertiary centres. Increased survival of extremely premature infants may change the incidence and outcome of necrotizing enterocolitis (NEC). Our aim was to examine the trends in the incidence of NEC, surgery and mortality in infants of 24–28 weeks gestation in a retrospective regional review of three epochs over a span of 14 years. Methods:  Radiologically or surgically proven NEC cases were determined from the New South Wales Neonatal Intensive Care Unit Study database. Three epochs were examined. A total of 360 infants were admitted in 1986–87 (Epoch 1), 622 in 1992–93 (Epoch 2) and 673 in 1998–99 (Epoch 3). Results:  There was an increase in neonatal intensive care unit admissions and a decrease in early and overall mortality of these very premature infants across the epochs. None of the early deaths was due to NEC. The incidence of NEC decreased in post day 5 survivors: 33 cases in Epoch 1 (12%), 60 cases in Epoch 2 (12%) and 34 cases in Epoch 3 (6%, P < 0.001). There was no change in surgical intervention (45%, 57% and 41%, respectively) or mortality due to NEC (37%, 27% and 32%). The reduced incidence of NEC was not singularly influenced by antenatal steroids, exogenous surfactant or outborn delivery. In a multivariate analysis, only later epoch of birth was independently associated with reduced NEC risk. Conclusions:  With improved care and survival of extremely premature infants, the incidence of NEC has decreased, but it remains a disease of high mortality and morbidity.
Epidemiology of necrotizing enterocolitis – Part II: Risks and susceptibility of premature infants during the surfactant era: A regional study
Authors: Luig Melissa , Lui Kei ,   NSW & ACT NICUS Group
Published: April 2005

Objectives:  We observed a reduced incidence of necrotizing enterocolitis (NEC) despite increased survival of extremely premature infants over the last two decades. A different susceptibility pattern to NEC according to gestation has been proposed. We aim to examine the influence of perinatal risk factors for NEC in infants less than 32 weeks gestation, in our region, in the post‐surfactant era. Methods:  NEC incidence, perinatal risk factors and neonatal outcomes were examined in a cohort of 4649 infants of 24–31 weeks gestation from the Neonatal Intensive Care Unit Study (NICUS) database, admitted during 1994–99. Results:  A total of 178 (3.8%) infants developed NEC. More 24–27 weeks infants than 28–31 weeks infants had NEC (6.6% vs 2.6%, P < 0.001). Although low gestation infants had higher mortality and surgery need, post‐operative survival (60%) was comparable to the higher gestation infants. NEC in the higher gestation group tended to be associated with perinatal risk factors, while risk factors were equally common in low gestation infants who developed NEC or not. Overall, gestation (P < 0.001), small for gestational age (P= 0.008), hyaline membrane disease (P < 0.001), placental abruption (P= 0.002) and earlier year of birth (P= 0.03) were independently associated with increased odds of NEC. Maternal hypertensive disease of pregnancy was associated with reduced NEC risk (P= 0.02). Conclusions:  The incidence of NEC continues to decrease in the surfactant era and the pattern of susceptibility to NEC is based on gestational age grouping and risk factors. The reduced risk associated with hypertensive disease of pregnancy is unexplained.
Prone or supine for infants with chronic lung disease at neonatal discharge?
Authors: Elder Dawn E , Campbell Angela J , Doherty Dorota A 
Published: April 2005

Objective:  To determine whether infants with chronic lung disease (CLD), ready for neonatal unit discharge, maintain cardiorespiratory stability while sleeping supine. Methods:  Subjects were 15 infants born <32 weeks gestational age (GA) and ready for discharge from the regional tertiary neonatal intensive care unit. Polysomnography recordings of sleep state, heart rate, arterial oxygen saturation, respiratory effort and nasal/oral airflow were taken prone and supine for up to 3 h post feed with the first position randomly allocated. The main outcome measures were oxygen saturation and apnoea hypopnoea index (AHI). Results:  Seven infants (median GA 27 weeks, birthweight 945 g) had CLD and eight infants (median GA 29 weeks, birthweight 1160 g) did not. CLD infants were more mature at study than non‐CLD infants (median 39 vs 36 weeks, P = 0.019). Neither oxygen saturation nor AHI were position dependent and no group differences were noted with respect to CLD status. There was a significant interaction of GA and sleep position with less‐mature infants spending less time in quiet sleep (QS) in supine position (P = 0.006). These less‐mature infants also had a higher AHI (P = 0.033). As expected, the AHI and arousal index (AI) were higher in active sleep (P ≤ 0.001, P = 0.013, respectively) and mean oxygen saturation was lower (P = 0.001). Conclusions:  The supine position appears appropriate for very preterm infants with CLD going home from the neonatal unit. Respiratory instability on neonatal discharge is more likely to be associated with immaturity than CLD.
The distraction test: The last word?
Authors: Russ Shirley A , Poulakis Zeffie , Wake Melissa , Barker Melinda , Rickards Field , Jarman Frederick C , Saunders Kerryn , Edwards Gwynne , Symons Lindsay , Oberklaid Frank 
Published: April 2005

Objective: Universal Newborn Hearing Screening (UNHS) programmes have been widely implemented, but their costs, benefits and long‐term logistics remain to be clearly defined. There are few rigorous evaluations of alternative strategies. In this paper, we evaluate the performance of the distraction test component of the two‐tiered Victorian Infant Hearing Screening Program (VIHSP). Methods: All babies born in the State of Victoria, Australia in 1993 who survived the neonatal period were screened for the presence of risk factors for hearing loss. Those at‐risk were referred for Auditory Brainstem Evoked Response (ABR) screening by a professional audiologist. All others were screened by modified distraction test at age 7–9 months. This birth cohort was followed through age 6 for diagnoses of congenital hearing loss resulting in fitting of hearing aids. Estimates of false‐positives, false‐negatives, sensitivity, specificity and positive predictive values were determined for the distraction test as a population screen. Ages at diagnosis and aid fitting for screen failures with hearing loss were compared with current goals. Results: For targeted (moderate or greater‐aided) losses, the distraction test yielded eight (0.02%) documented false‐negatives (one severe and seven moderate) and an estimated 4265 (99%) false‐positives. Distraction test sensitivity was 65%, specificity 91% and PPV 0.3%. Mean age at diagnosis for distraction test failures across all severities, including mild losses, was 23 (SD 18) months with a mean age at aid fitting of 26 (SD 20) months. Conclusions: The distraction test screen generated large numbers of false‐positives and a significant number of false‐negatives, performing particularly poorly with moderate losses. Ages at diagnosis and aid fitting for screen failures were far older than currently accepted goals. There is little evidence that the distraction test can be made to work acceptably as a population‐based screen.
Physician counselling practices and decision‐making for extremely preterm infants in the Pacific Rim
Authors: Martinez Alma M , Partridge J Colin , Yu Victor , Wee Tan Keng , Yeung Chap‐Yung , Lu Jen‐Her , Nishida Hiroshi , Boo Nem‐Yun 
Published: April 2005

Objectives:  This study was undertaken to evaluate physician counselling practices and resuscitation decisions for extremely preterm infants in countries of the Pacific Rim. We sought to determine the degree to which physician beliefs, parents' opinion and medical resources influence decision‐making for infants at the margin of viability. Methods:  A survey was administered to neonatologists and paediatricians who attend deliveries of preterm infants in Australia, Hong Kong, Japan, Malaysia, Taiwan and Singapore. Questions were asked regarding physician counselling practices, decision‐making for extremely preterm infants and demographic information. Results:  Physicians counsel parents antenatally with increasing frequency as gestational age increases. Most physicians discuss infant mortality and morbidity with parents prior to delivery. Physicians less frequently discuss the option of no resuscitation of an extremely preterm infant, withdrawal of support at a later time, or financial costs to parents. Severe congenital malformations, perception of a poor future quality of life, parental wishes and a high probability of death for the infant are influential in limiting resuscitation in very preterm infants for a majority of physicians. Less influential factors are parent socioeconomic status, language barriers, financial costs for the family, allocation of national resources, moral or religious considerations, or fear of litigation. Physician thresholds for resuscitation of infants ranged between 22 and 25 weeks gestation and between 400 and 700 g birthweight. Conclusions:  We report physician beliefs and practices regarding resuscitation and the counselling of parents of extremely preterm infants in Pacific Rim countries. While we find variation among countries, physician practices appear to be determined by ethical decision‐making and medical factors rather than social or economic factors in each country.
Cooperative partnerships or conflict‐of‐interest? A national survey of interaction between the pharmaceutical industry and medical organizations
Authors: Kerridge I. , Maguire J. , Newby D. , McNeill P. M. , Henry D. , Hill S. , Day R. , Macdonald G. , Stokes B. , Henderson K. 
Published: April 2005

Abstract Background:  There is extensive and varied interaction between the pharmaceutical industry and the medical profession. Most empirical research concerns contact between individual physicians and industry, and reflects North American experience. We sought to clarify the extent and nature of relationships between the pharmaceutical industry and Australian medical organizations.Methods:  We administered questionnaires to 63 medical organizations concerned with clinical practice, continuing medical education or professional accreditation, or the political representation of medical professionals.Results:  Survey instruments were received from 29 organi­zations, giving a response rate of 46%. Seventeen of these organizations (59%) had received support from one or more pharmaceutical company in the past financial year. Support was predominantly for annual conferences, with some support for continuing medical education, research, travel and library purchases. The majority of organizations had an academic journal or newsletter, and 10 (34%) accepted revenue from pharmaceutical advertising. Twenty organizations (72%) had policies or guidelines covering their relationship with industry. Few organizations indicated that they would be unable to continue their activities without pharmaceutical industry support.Conclusion:  These data indicate a high level of inter­action between the pharmaceutical industry and medical organizations in Australia. While most organizations have policies for guiding their relationship with industry, it is unclear whether these are effective in preventing conflicts of interest and maintaining public trust. (Intern Med J 2005; 35: 206–210)
Prospective study of treatment with selective internal radiation therapy spheres in patients with unresectable primary or secondary hepatic malignancies
Authors: Lim L. , Gibbs P. , Yip D. , Shapiro J. D. , Dowling R. , Smith D. , Little A. , Bailey W. , Liechtenstein M. 
Published: April 2005

Abstract Aim:  To prospectively evaluate the efficacy and safety of Selective Internal Radiation (SIR) Spheres (Sirtex Medical, Sydney, NSW, Australia) in patients with unresectable primary or secondary hepatic malignancies.Methods:  We report our experience of SIR sphere therapy at three Australian centres. Patients with previously untreated colorectal cancer (CRC) received concurrent 5FU, other patients with CRC received 5‐FU at investigator discretion and all other patients received SIR spheres alone.Results:  Forty‐six patients were enrolled between January 2002 and June 2003. The majority (32 patients) had metastatic colorectal cancer and five patients had hepatocellular carcinoma. The median age of patients was 64 years (range 46–78 years). Forty‐three patients were evaluable for response. There were 12 partial responses, of which 10 were in patients with CRC. The median duration of response for all patients was 8.6 months (range 2–21 months). Overall treatment related toxicity was acceptable. Significant late toxicity included four cases of severe gastric ulceration, despite standard work‐up and treatment by experienced interventional radiologists.Conclusion:  In this series of patients, treatment with SIR‐spheres has demonstrated modest activity, mostly observed in patients with CRC. Toxicity was substantial in a small number of patients. (Intern Med J 2005; 35: 222–227)
Radiotherapy in the management of solitary extramedullary plasmacytoma
Authors: Chao M. W. , Gibbs P. , Wirth A. , Quong G. , Guiney M. J. , Liew K. H. 
Published: April 2005

Abstract Background:  Solitary extramedullary plasmacytoma (SEP) is a rare tumour for which the standard treatment remains local radiotherapy (RT). We present a study of a multi‐institutional experience, between 1980 and 1999, in an attempt to better understand the natural history of SEP and to identify possible prognostic factors.Methods:  The records at Radiation Oncology Victoria and Peter MacCallum Cancer Centre, Melbourne, were used for the identification of patients. The inclusion criteria were as follows: (i) histological confirmation of clonal plasma cells involving a single extramedullary site with or without lymph node involvement; (ii) no histological evidence of bone marrow involvement; (iii) no evidence of distant bone lesion on radiographic skeletal survey (bone erosions adjacent to the primary thought to be due to contiguous involvement were permitted) and (iv) no anaemia, hypercalcaemia or renal impairment due to plasma cell dyscrasia.Results:  A total of 16 patients was identified, with a median follow up of 66 months (range 12–211 months). The head and neck region accounted for the majority of presentations (88%). Among all patients, a serum mono­clonal paraprotein was found in three patients and bone erosion was identified in seven patients. All patients received local RT, although two patients also received elective nodal irradiation (ENI). The median RT dose was 45 Gy (range 40–50.4 Gy). Local control was achieved in all patients (100%), however, regional recurrence outside the RT fields occurred in 2/16. Multiple myeloma (MM) developed in five patients, all within 5 years. The predicted 10‐year myeloma free survival is 75% and 10‐year overall survival is 54%.Conclusion:  RT can achieve excellent local control of SEP. The rate of conversion to MM is 31%. Moderate dose RT of at least 40 Gy using limited radiation fields is recommended, although ENI should be considered if toxicity is not increased. (Intern Med J 2005; 35: 211–215)
Lymphocytic hypophysitis: a rare cause of hypoglycaemia in a man with type 2 diabetes mellitus
Authors: Lee P. , Chrysostomou A. , Tress B. , Ebeling P. R. 
Published: April 2005

Abstract Lymphocytic hypophysitis is a primary inflammatory disorder of the pituitary gland, which may cause panhypopituitarism. The majority of cases occur in women during the peripartum period and it is rare in men. We present a case, initially presenting with recurrent hypoglycaemic episodes, in a man with previously well‐controlled type 2 diabetes mellitus. (Intern Med J 2005; 35: 254–257)