bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatricians' Response to the Demand for School Health Programming
Authors: Barnett Stephen , Duncan Paula , O'Connor Karen G. 
Published: August 2004

Objective.Because of the broad and increasing interest in school health, the American Academy of Pediatrics (AAP) surveyed its members to determine their awareness of school health education/programs, their level of participation, their desire to participate, and their resource needs to participate more effectively.Methods.Self-administered questionnaires were mailed to a randomized representative sample of AAP members (N= 1602). Overall response rate was 64.5%. Some responses were stratified for analysis by gender; age (&gt;45 years or ≤45 years); practice area (urban, suburban, or rural); practice setting (solo, group, or hospital); and type of practice (general versus specialty). χ2 Tests were used to compare responses.Results.Greater than half of the pediatricians who responded to the questionnaire were aware of school health education curriculum on risky adolescent behaviors in their community, counseling services (58%), school nursing services (63%), and screening services (71%); however, more than half were not aware of curriculum on injury/violence prevention, fitness, or whether a school health advisory council was available. Most pediatricians supported comprehensive school health education (pregnancy prevention, 82%; violence prevention, 77%; mental health, 56%). Also, respondents supported services (counseling, 76%; nutrition, 65%; screening/referral, 58%; school-based primary care, 58%). Although 22% of AAP pediatricians are currently working with local school programs, &gt;70% wanted to become involved or more involved and needed information on how they may be able to participate. Only 25% believed they were adequately prepared. Two thirds believed school-based clinics were one of the best ways to reach underserved children and adolescents and should include preteens.Conclusion.AAP pediatricians want to become more involved with comprehensive school health programs. The ways in which they want to participate vary substantially. Most pediatricians thought they needed additional education. The AAP has developed recommendations for graduate medical education and continuing medical education for pediatricians to participate in integrated school health services.
A Phase I Study of Abacavir (1592U89) Alone and in Combination With Other Antiretroviral Agents in Infants and Children With Human Immunodeficiency Virus Infection
Authors: Kline Mark W. , Blanchard Suzette , Fletcher Courtney V. , Shenep Jerry L. , McKinney Ross E. , Brundage Richard C. , Culnane Mary , Van Dyke Russell B. , Dankner Wayne M. , Kovacs Andrea , McDowell James A. , Hetherington Seth ,   for the AIDS Clinical Trials Group 330 Team
Published: August 2004

Objectives.To evaluate the pharmacokinetic features, safety, and tolerance of abacavir, given alone and in combination with other nucleoside antiretroviral agents, in symptomatic human immunodeficiency virus (HIV)-infected children.Methods.HIV-infected children discontinued prior antiretroviral therapy and were given abacavir orally, 4 mg/kg every 12 hours for 6 weeks, followed by 8 mg/kg every 12 hours for 6 weeks (n = 39); or 8 mg/kg every 12 hours for 12 weeks (n = 8). Children then were randomized to receive a second nucleoside antiretroviral agent (zidovudine, stavudine, didanosine, or lamivudine), plus abacavir. Pharmacokinetics, safety, tolerance, CD4+ lymphocyte counts, and plasma HIV RNA concentrations were evaluated.Results.At a dose of 8 mg/kg every 12 hours, area under the plasma concentration-versus-time curves and plasma half-life values were comparable with those reported for adults receiving abacavir at a dose of 300 mg twice daily. One case each of hypersensitivity reaction and peripheral neuropathy occurred during abacavir monotherapy. Three children experienced neutropenia while receiving abacavir in combination with another antiretroviral agent. Mean CD4+lymphocyte count and plasma HIV RNA concentration did not change when prior antiretroviral therapy was changed to abacavir monotherapy.Conclusions.Abacavir therapy is associated with good short-term tolerance and safety in HIV-infected children. Phase III studies are in progress to assess the antiviral activity of abacavir in children and adults.
Lack of Vancomycin-associated Nephrotoxicity in Newborn Infants: A Case–Control Study
Authors: Bhatt-Mehta Varsha , Schumacher Robert E. , Faix Roger G. , Leady Michelle , Brenner Timothy 
Published: August 2004

Objective.
The purpose of this study was to compare the incidence of nephrotoxicity, defined as doubling of baseline serum creatinine concentration, in newborn infants with peak vancomycin serum concentrations ≤40 μg/mL at steady state to infants with peak vancomycin serum concentrations &gt;40 μg/mL. A secondary objective was to correlate concomitant disease states and potentially nephrotoxic drug therapy with rises in serum creatinine in vancomycin recipients.

Methods.
Newborn infants with culture-provenStaphylococcus aureus or coagulase-negative staphylococcal septicemia who received vancomycin therapy for &gt;3 days between 1985 and 1995 were identified from an existing database and a review of medical record. All 69 patients included in the study had serial serum creatinine determinations, including a baseline value within 48 hours of starting treatment with vancomycin, and serum vancomycin concentrations determined after at least three doses, with peak and trough concentrations determined 1 hour after a 60-minute infusion and 15 to 30 minutes before a dose, respectively. Infants with congenital renal or cardiac anomalies were excluded. Demographic characteristics, vancomycin dosing regimen, serum vancomycin concentrations and sample times, concomitant drug therapy, and disease states were recorded. Patients were divided into group A (peak vancomycin concentration ≤40 μg/mL) and group B (peak vancomycin concentration &gt;40 μg/mL). The change in serum creatinine concentration between the start and end of vancomycin therapy was determined. Nephrotoxicity was identified if serum creatinine doubled at any time from the start to the end of vancomycin therapy. Alternative definitions of nephrotoxicity (any rise in serum creatinine to &gt;0.6 mg/dL or new abnormalities of urine sediment) were used in additional analyses.

Results.
A total of 69 evaluable patients (gestational age, 28.9 ± 3.0 weeks; birth weight, 1219 ± 516 g) were identified, 61 in group A and 8 in group B. Six patients in group A underwent doubling of serum creatinine concentration during vancomycin therapy, whereas none in group B did so. Serum creatinine doubled to &gt;0.6 mg/dL in only 3 infants (all in group A). Any increase in serum creatinine to &gt;0.6 mg/dL was seen in 10 infants, 9 of whom were in group A. No confounding variable, including previous or concomitant underlying disease states associated with renal dysfunction or treatment with other potentially nephrotoxic agents, were associated with a significant rise in serum creatinine.

Conclusion.
Vancomycin-associated nephrotoxicity is rare in neonates, even with serum peak concentrations &gt;40 μg/mL.
Diagnostic Testing Unwarranted for Children With Blood Lead 10 to 14 μg/dL
Authors: Sargent James D. , Dalton Madeline , Klein Robert Z. 
Published: August 2004

Background.Recent statements from the American Academy of Pediatrics and Centers for Disease Control and Prevention recommend diagnostic venous blood lead testing within 90 days of a marginally elevated screening test (10–14 μg/dL).Objective.To evaluate the ability of a marginally elevated capillary (CScr) or venous (VScr) blood lead screening test to predict venous diagnostic (VPb) blood lead (taken within 90 days of the screening test) that would prompt environmental evaluation (≥20 μg/dL).Design.Population-based follow-up study comparing CScr and VScr with VPb drawn within 90 days of the screening sample. This study population was drawn from all children aged 0 to 4 years who were screened in Worcester County, Massachusetts, and Providence County, Rhode Island, with CScr and VScr during calendar year 1994.Outcome Measures.To evaluate predictive validity, CScr and VScr were correlated with VPb. CScr, VScr, and VPb results were then separated into the following categories: &lt;10, 10 to 14, 15 to 19, and ≥20 μg/dL. CScr and VScr categories were cross-tabulated against VPb categories, and logistic regression analysis was used to evaluate categorical elevations of CScr and VScr as predictors of VPb ≥20 μg/dL.Results.Of 31 904 children screened with CScr, 5450 (17.1%) were elevated and 1278 were followed up with VPb within 90 days. Of 14 623 children screened with VScr, 2979 (20.4%) were elevated and 614 were followed up with VPb within 90 days. CScr was only weakly correlated with VPb (r = 0.39), whereas VScr was more strongly correlated with VPb (r = 0.73). Compared with CScr &lt;10 μg/dL, CScr in the 10 to 14 μg/dL range did not identify a higher percentage of children with VPb elevation in any category, and falsely misclassified as lead poisoned some 77% of children. Compared with VScr &lt;10 μg/dL, VScr in the 10 to 14 μg/dL range identified higher percentages of children with VPb in the 10 to 19 μg/dL range but not with VPb ≥20 μg/dL, and falsely misclassified as lead poisoned 42% of children. Compared with screening tests &lt;10 μg/dL, the odds of identifying a child with VPb ≥20 were no different from 1 for CScr of 10 to 14 μg/dL (adjusted odds ratio 1.4 [95% confidence interval 0.3, 6.6]), CScr of 15 to 19 μg/dL (3.2 [0.7, 15.7]), or VScr of 10 to 14 μg/dL (0.9 [0.3, 3.0]). CScr and VScr in the 15 to 19 μg/dL range were associated with significantly higher odds of having VPb ≥20 μg/dL when compared with screening tests &lt;10 μg/dL.Conclusions.These data indicate that special diagnostic testing within 90 days for children with CScr and VScr in the 10 to 14 μg/dL range does not result in greater identification of VPb ≥20. Raising the set point for diagnostic testing to 15 μg/dL in this sample would eliminate the unnecessary follow-up of 5162 children, of whom 3360 were falsely misclassified as having undue lead exposure.
Neonatal Necrotizing Fasciitis: A Report of Three Cases and Review of the Literature
Authors: Hsieh Wu-Shiun , Yang Peng-Hong , Chao Hsun-Chin , Lai Jin-Yao 
Published: August 2004

Objective.Necrotizing fasciitis (NF) is a predominantly adult disorder, with bacterial infection of the soft tissue. In children, it is relatively rare and has a fulminant course with a high mortality rate. In the neonate, most cases of NF are attributable to secondary infection of omphalitis, balanitis, mammitis, postoperative complications, and fetal monitoring. The objective of this communication is to report 3 cases of neonatal NF and provide a literature review of this disorder.Results.This review yielded 66 cases of neonatal NF. Only 3 cases were premature. There was no sex predilection and the condition rarely recurred. Several underlying conditions were identified that might have contributed to the development of neonatal NF. These included omphalitis in 47, mammitis in 5, balanitis in 4, fetal scalp monitoring in 2, necrotizing enterocolitis, immunodeficiency, bullous impetigo, and maternal mastitis in 1 patient each. The most common site of the initial involvement was the abdominal wall (n = 53), followed by the thorax (n = 7), back (n = 2), scalp (n = 2), and extremity (n = 2). The initial skin presentation ranged from minimal rash to erythema, edema, induration or cellulitis. The lesions subsequently spread rapidly. The overlying skin might later develop a violaceous discoloration, peau d'orange appearance, bullae, or necrosis. Crepitus was uncommon. Fever and tachycardia were frequent but not uniformly present. The leukocyte count of the peripheral blood was usually elevated with a shift to the left. Thrombocytopenia was noted in half of the cases. Hypocalcemia was rarely reported. Of the 53 wound cultures available for bacteriologic evaluation, 39 were polymicrobial, 13 were monomicrobial, and 1 was sterile. Blood culture was positive in only 20 cases (50%). Treatment modalities included the use of antibiotics, supportive care, surgical debridement, and drainage of the affected fascial planes. Two of the 6 cases who received hyperbaric oxygen therapy died. The overall mortality rate was 59% (39/66). In 12 cases, skin grafting was required because of poor granulation formation or large postoperative skin defects among the survivors.Conclusion.Neonatal NF is an uncommon but often fatal bacterial infection of the skin, subcutaneous fat, superficial fascia, and deep fascia. It is characterized by marked tissue edema, rapid spread of inflammation, and signs of systemic toxicity. The wound cultures are predominantly polymicrobial and the location of initial involvement depends on the underlying etiologic factor. High index of suspicion, prompt aggressive surgery, appropriate antibiotics, and supportive care are the mainstays of management in the newborn infant with NF.
Mothers With Histories of Domestic Violence in a Pediatric Emergency Department
Authors: Duffy Susan J. , McGrath Meghan E. , Becker Bruce M. , Linakis James G 
Published: August 2004

Objective.
To determine the prevalence of domestic violence against mothers in a pediatric emergency department and the relationship of their children to the abusers.

Design.
Cross-sectional survey of a convenience sample of mothers seeking treatment for their children.

Setting.
An urban pediatric emergency department.

Participants.
A total of 157 mothers with children &lt;3 years of age. Women were excluded if older children or partners were present.

Results.
A total of 52% of women reported histories of adult physical abuse, 21% reported adult sexual abuse, and 28% reported childhood sexual abuse. A total of 10% of women were in abusive relationships in the past year. Victims of adult physical abuse were more likely to report histories of adult sexual abuse (relative risk [RR]: 4.93) or childhood sexual abuse (RR: 3.13). Intimate partners perpetrated 67% of physical abuse and 55% of sexual abuse. Relatives perpetrated 66% of childhood sexual abuse. Women who revealed histories of childhood sexual abuse were more likely to report adult sexual abuse (RR: 4.93). A total of 40% of the perpetrators of adult physical abuse, 73% of the perpetrators of past year physical abuse, and 10% of the perpetrators of adult sexual abuse had regular contact with their victims' children.
Health care providers screened only 21% of the women for past violence. Victims of domestic violence were no more likely to have been screened than those without histories of physical or sexual abuse.

Conclusions.
Mothers of young patients in a pediatric emergency department are often victims of domestic violence. Perpetrators are often close relatives and thus place the victims' children at risk for abuse and for the psychological trauma of witnessing violence. Given the prevalence of domestic violence, families may benefit from routine violence screening and interventions in pediatric emergency departments.
Experience, Brain, and Behavior: The Importance of a Head Start
Authors: Eisenberg Leon 
Published: August 2004

Nature and nurture stand in reciprocity, not opposition. All children inherit—along with their parents' genes—their parents, their peers, and the communities they live in. Development unfolds in an ecologic and a social setting which, just like the genes, is decisive in shaping the organism. The social niche is a crucial link between parents and offspring, an envelope of life chances. It is high time to replace the false dichotomy between nature versus nurture by a more inclusive trio: nature, niche, and nurture.
Major brain pathways are specified in the genome, but the learned connections between brain and behavior are fashioned by social experience. The luxuriant overgrowth of neurons and their processes in embryonic and early life provides the substrate for environmentally induced structural change. Activity selects out the synapses that will persist; inactivity results in regression and apoptosis. Learning begins in utero and accelerates after birth. Responsive interactions between infants, their parents, and other caretakers is crucial to biological no less than psychosocial development. Comprehensive pediatric care can help provide a head start to enhance brain development and put the mind on the road to adaptive maturity.
Trampolines at Home, School, and Recreational Centers
Authors:   Committee on Injury and Poison Prevention and Committee on Sports Medicine and Fitness
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2012-2082.
The latest available data indicate that an estimated 83 400 trampoline-related injuries occurred in 1996 in the United States. This represents an annual rate 140% higher than was reported in 1990. Most injuries were sustained on home trampolines. In addition, 30% of trampoline-related injuries treated in an emergency department were fractures often resulting in hospitalization and surgery. These data support the American Academy of Pediatrics' reaffirmation of its recommendation that trampolines should never be used in the home environment, in routine physical education classes, or in outdoor playgrounds. Design and behavioral recommendations are made for the limited use of trampolines in supervised training programs.
Deaths Attributable to Injuries in Infants, United States, 1983–1991
Authors: Brenner Ruth A. , Overpeck Mary D. , Trumble DrPh; Ann C. , DerSimonian Rebecca , Berendes Heinz 
Published: August 2004

ObjectiveTo describe risk factors for injury death among infants in the United States by the specific external cause of death.Methods.Data were analyzed from the US-linked birth/infant death files for the years 1983–1991. Potential risk factors for injury death were identified from birth certificate data and included both maternal and infant factors. Injury rates were calculated by external cause of death. Characteristics of infants who died from an injury were compared with those of the entire birth cohort. The independent effect of potential risk factors was assessed in multivariate analyses using a case–control study design.Results.A total of 10 370 injury deaths were identified over the 9-year study period (29.72/100 000 live births). The leading causes of death were homicide, suffocation, motor vehicle crashes, and choking (inhalation of food or objects). There was no significant temporal trend in the overall rate of injury death; however, this was because significant increases in the rates of death from homicide (6.4%/year) and mechanical suffocation (3.7%/year) were offset by decreases in rates of death from fires (−4.7%/year) and choking (−4.6%/year). In adjusted analyses, infants born to mothers with no prenatal care, &lt;12 years of education, two or more previous live births, Native American race, or &lt;20 years of age were at twice the risk of injury death compared with the lowest risk groups (initiation of prenatal care in the first trimester, ≥16 years of education, no previous live births, white, or ≥25 years of age). When analyzed by the specific cause of death, the factors that were associated most strongly with death varied. For example, Native Americans were at greatest risk of a motor vehicle related death (compared with whites: OR: 3.6; 95% CI: 1.8–7.1), and infants with birth weights of &lt;1500 g were at greatest risk of death attributable to inhalation of food (compared with ≥2500 g: OR: 9.6; 95% CI: 3.3–28.0) or objects (OR: 11.8; 95% CI: 4.5–30.5).Conclusion.A number of sociodemographic characteristics are associated with an increased risk of injury-related death in infants. The strength of associations between specific risk factors and death varies with the external cause of death, thus identifying high-risk subgroups for targeting of cause-specific interventions and simultaneously increasing our understanding of the individual and societal mechanisms underlying these tragedies. infant, injury, suffocation, motor vehicle, homicide, drowning, inhalation, fire.
Psychological Symptoms in Chronic Fatigue and Juvenile Rheumatoid Arthritis
Authors: Carter Bryan D. , Kronenberger William G. , Edwards Joseph F. , Marshall Gary S. , Schikler Kenneth N. , Causey David L. 
Published: August 2004

Objective.To determine if psychological morbidity in youth with chronic fatigue is caused by the stress of coping with a chronic illness.Study Design.Case–control study comparing pediatric patients with debilitating chronic fatigue and matched subjects with juvenile rheumatoid arthritis, a chronic medical illness with similar functional sequelae.Setting.Pediatric Infectious Diseases Clinic and Juvenile Rheumatoid Arthritis Clinic of Kosair Children's Hospital.Participants.Nineteen children and adolescents with debilitating chronic fatigue and 19 age- and sex-matched peers with juvenile rheumatoid arthritis.Outcome.Structured Interview, Kaufman Brief Intelligence Test, Child Behavior Checklist, and Youth Self-Report.Results.Intellectual functioning on the Kaufman Brief Intelligence Test Composite was average (103, standard score) for both groups. Pediatric patients with chronic fatigue had higher levels of internalizing psychological distress than patients suffering from juvenile rheumatoid arthritis, despite the fact that both groups had a similar pattern of decline in social and physical activities. Duration of illness did not explain the difference in psychological symptoms.Conclusions.Psychological factors may play a more active role in debilitating chronic fatigue in pediatric patients than can be explained by the stress of coping with a similar chronic, non–life-threatening illness.