bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Behavior Problems Associated With Delayed School Entry and Delayed School Progress
Authors: Byrd Robert S. , Weitzman Michael , Auinger Peggy 
Published: August 2004

Objective. To investigate whether students who are old-for-grade have higher rates of reported behavior problems and to investigate whether this association is independent of having been retained a grade in school.Methods. Cross-sectional analyses of parental reports from the nationally representative sample of 9079 children ages 7 to 17 years who participated in the Child Health Supplement to the 1988 National Health Interview Survey. Students older than the modal age for their grade were considered old-for-grade, either due to delayed school entry (those without grade retention) or to delayed school progress (with history of grade retention). Behavior problems were defined as scores &gt;90th percentile on a well-utilized, standardized Behavior Problem Index (BPI).Results. Twenty-six percent of 7- to 17-year-old children in the United States are old-for-grade. Being old-for-grade is more common in males (31%), blacks (33%), Hispanics (32%), those living in single-parent households (31%) or poverty (43%), and those with mothers with low educational attainment (42%). Most children (84%) who repeated a grade are old-for-grade, but only 54% of old-for-grade students have been retained. For children who were old-for-grade, 19% of those grade-retained and 12% of those nonretained had extreme BPI scores, and for those not old-for-grade, 17% of grade-retained and 7% of nonretained children had extreme BPI scores. Although rates of extreme BPI scores were consistently lower for children who were neither old-for-grade nor grade-retained, and consistently higher for those with both, these rates increased with age for children who were old-for-grade without being retained. Controlling for multiple potential confounders with logistic regression, both old-for-grade status and grade retention are independently associated with increased rates of behavior problems. Separate logistic regression analyses for blacks and whites showed that these findings pertained only to white children.Conclusions. Whereas grade retention is associated with increased rates of behavior problems in children and adolescents, simply being older than others in one's class, without having experienced grade retention, is also associated with increased rates of behavior problems, most noticeably among adolescents. These data suggest that there may be latent adverse behavioral outcomes that result from delaying children's school entry.
Endocrinologic Disorders and Optic Pathway Gliomas in Children With Neurofibromatosis Type 1
Authors: Cnossen Marjon H. , Stam Esther N. , Cooiman Linda C. M. G. , Simonsz Huibert J. , Stroink Hans , Oranje Arnold P. , Halley Dicky J. J. , de Goede-Bolder Arja , Niermeijer Martinus F. , Keizer-Schrama Sabine M. P. F. de Muinck 
Published: August 2004

Objective. To establish the prevalence of endocrinologic disorders in children with neurofibromatosis type 1 (NF1) and the relationship between these disorders and cerebral abnormalities on magnetic resonance imaging.
Design. A prospective follow-up study.
Setting. A multidisciplinary neurofibromatosis clinic.
Patients. A total of 122 children diagnosed with NF1 according to diagnostic criteria set by the National Institutes of Health.
Results. Central precocious puberty (CPP) was diagnosed in 3 children and growth hormone deficiency (GHD) in 3 children. Optic pathway gliomas were observed in 15 children; in 9 of the 15 cases, the optic chiasm was involved. Of the 3 children with CPP, only 1 showed a chiasma glioma on magnetic resonance imaging. In 1 case with GHD, an optic chiasm glioma was detected on neuroimaging. Two of the 9 children with an optic chiasm glioma presented with CPP or GHD.
Conclusions. It has been suggested that CPP in children with NF1 is found exclusively in the presence of a chiasma glioma. We conclude that chiasma glioma may not be obligatory in children with NF1 and CPP or GHD. Moreover, we report a prevalence of GHD in children with NF1 of 2.5%, which has not been established earlier.
Bone Mineral Density in Prepubertal and in Adolescent and Young Adult Patients With the Salt-wasting Form of Congenital Adrenal Hyperplasia
Authors: Gussinyé Miquel , Carrascosa Antonio , Potau Neus , Enrubia Manuel , Vicens-Calvet Enric , Ibáñez Lourdes , Yeste Diego 
Published: August 2004

Objective. To evaluate bone mineral density (BMD) in prepubertal and in adolescent and young adult patients with the salt-wasting form of congenital adrenal hyperplasia (CAH).
Design. A relationship between bone mineral content and risk for osteoporotic fractures has been observed in adulthood. Infancy, childhood, and adolescence are critical periods for skeletal mineralization; thus, chronic diseases may impair bone mass peaking, particularly if children and adolescents are overexposed to glucocorticoids, as may occur in patients with CAH.
Lumbar L2–L4 BMD values were measured by dual x-ray absorptiometry and compared with those of 471 age- and sex-matched controls.
Patients. Thirty-three patients with the salt-wasting form of CAH were studied. Sixteen (10 girls and 6 boys; age range, 1.5 to 8.3 years) were prepubertal and 17 (13 women and 4 men; age range, 17.1 to 28.2 years) were adolescent and young adults who had reached final height and had presented normal pubertal development and normal gonadal function thereafter. The average doses of hydrocortisone (mg/m2 body surface/day) received from diagnosis in the neonatal period to BMD evaluation were 21.2 ± 2.2 and 22.3 ± 2.6, respectively.
Results. Mean BMD Z score values were 0.16 ± 1.01 in prepubertal patients and 0.06 ± 1.02 in adolescent and young adult patients with no statistically significant differences with age- and sex-matched controls. Mean heightZ score values were −0.03 ± 1.13 in prepubertal patients and −1.13 ± 0.62 in adolescent and young adult patients with significant differences between the latter and their respective age- and sex-matched controls.
Conclusion. Long-term glucocorticoid therapy does not impair bone mass peaking in CAH patients with normal gonadal function, even though their adult height values are low.
The University of Massachusetts Medical Center Office-based Continuity Experience: Are We Preparing Pediatrics Residents for Primary Care Practice?
Authors: Roberts Kenneth B. , Starr Susan , DeWitt Thomas G. 
Published: August 2004

Objective. Surveys of residency graduates and employers have suggested that residency programs do not prepare residents well for practice. Since 1988, pediatric residents at the University of Massachusetts have been paired one-on-one with an office-based pediatrician for their 3-year continuity experience. This survey was conducted to determine if graduates of such a program are prepared to enter pediatric practice.Methodology. Graduates of the program from 1991 through 1995 who entered primary care practice were surveyed about their preparedness for practice. The questionnaire was also sent to the residents' first employers. The 32 questions were directed to overall sense of preparedness, ability to manage the pace of practice, common illnesses, common behavior problems, anticipatory guidance, office management, and subspecialty problems.Results. Data from all 25 residents who entered practice and the employers of 20 of the 25 residents were obtained and analyzed. Both groups rated overall resident preparedness to be “well-prepared” or “very well-prepared” and gave high scores on working at the pace of practice, diagnosing and treating common illnesses, diagnosing and treating common behavior problems, and providing anticipatory guidance. Areas in which residents were considered to be less well-prepared included anticipatory guidance about nutrition, managing problems by telephone, office management, gynecology, and orthopedics.Conclusions. The results suggest that continuity experiences in office practices are associated with preparation for the pace and types of visits that occur commonly in primary care practice, abilities which previous surveys of residency alumni and employers have found lacking. Some areas may benefit from a formal curriculum which may be implemented in the office practice, at the medical center, or at both sites. Preceptors may benefit from faculty development and continuing medical education that is directed not only at teaching skills but also at content areas which were not addressed in their own residencies.
A Prospective Randomized Trial of Feeding Methods in Very Low Birth Weight Infants
Authors: Akintorin Subuola M. , Kamat Medha , Pildes Rosita S. , Kling Patricia , Andes Steven , Hill Joan , Pyati Suma 
Published: August 2004

Objective. To test the hypothesis that very low birth weight infants fed by continuous nasogastric gavage (CNG) would achieve full enteral feedings (100 kcal/kg/d) at an earlier postnatal age and have less feeding intolerance (FI) than infants fed by intermittent bolus gavage (IBG).Methods. Eighty infants were stratified by birth weight (700 to 1000 g and 1001 to 1250 g) and randomized into CNG or IBG feeding groups. CNG infants were comparable with IBG in birth weight, gestational age, sex, race, and day of onset of feeding (5.7 ± 2.1 days vs 5.6 ± 2.2 days, respectively). Feedings were given as undiluted Similac Special Care formula (Ross Laboratories, Columbus, OH) via a specific protocol designed for each 50 to 100 g birth weight category. Feedings were advanced isoenergetically by a maximum of 25 mL/kg/d until an endpoint of 100/kcal/kg/d for at least 48 hours was reached. An infant whose feedings were withheld for &gt;12 hours based on predetermined criteria was considered to have an episode of FI.Results. Infants in the CNG group reached full enteral feeding at 17.1 ± 8.9 days compared with 15.5 ± 5.5 days in the IBG group; these were not statistically different. Secondary outcome variables such as days to regain birth weight (CNG, 12.6 ± 5 days vs IBG, 12.5 ± 3.7 days), days to reach discharge weight of 2040 g (CNG, 60 ± 13.4 days vs IBG, 62 ± 13.6 days), and number of episodes of FI were not significantly different between feeding methods. FI was primarily associated with birth weight ≤1000 g (71%) vs 1001 to 1250 g (38%).Conclusion. Feeding methods are associated with similar outcomes when feeding regimens are comparable.
Two Cases of Incontinentia Pigmenti Simulating Child Abuse
Authors: Ciarallo Lydia , Paller Amy S. 
Published: August 2004

In the United States 1.4 million children were maltreated in 1988, resulting in an estimated 2000 to 5000 deaths.1Largely due to the rising awareness and sensitivity to the horrors of child abuse, the number of deaths declined to approximately 1500 in 1993.2 Guidelines have been published to aid in the identification and management of child maltreatment,3 and reporting of all suspicious cases is mandated by law. In our zealous efforts to protect children, some families are investigated because of misdiagnosed abnormalities, often cutaneous,4 leading to the unintentional injury of both patients and their families.5In this report, we describe two patients with cutaneous and/or visceral manifestations of incontinentia pigmenti (IP) who were initially thought to be victims of child abuse.
Regulation of Growth of 7- to 36-Month-Old Children by Energy and Fat Intake in the Prospective, Randomized STRIP Baby Trial
Authors: Niinikoski Harri , Viikari Jorma , Rönnemaa Tapani , Helenius Hans , Jokinen Eero , Lapinleimu Helena , Routi Taina , Lagström Hanna , Seppänen Ritva , Välimäki Ilkka , Simell Olli 
Published: August 2004

Objective. To study the fat and energy intakes of children between 7 and 36 months of age with different growth patterns.Methods. In the Special Turku coronary Risk factor Intervention Project for Babies, children were randomized to intervention (n = 540) and control groups (n = 522) at age 7 months. The intervention was aimed at replacing part of the saturated fat intake with monounsaturated and polyunsaturated fat to reduce children's exposure to high serum cholesterol values. The control children consumed a free diet. Children followed for &gt;2 years (n = 848) were included in the analysis. Five groups of children representing different extreme growth patterns during the first 3 years of life were formed, and their energy and fat intakes were analyzed. Relative weight was defined as deviation of weight in percentages from the mean weight of healthy children of same height and sex, and relative height as deviation of height in SD units from the mean height of healthy children of same age and sex.Results. Relative fat intakes (as percent of energy intake) were similar in children showing highly different height gain patterns. The thin (mean relative weight ≤ 5%) children consumed more fat (mean, 30% energy [ E%] [SD 7] at 13 months and 33 [4] E% at 24 months) than children with normal growth (27 [5] E% at 13 months and 31 [5] E% at 24 months). The energy intake of the tall (mean relative height ≥ 95%) and the obese (mean relative weight ≥ 95%) were highest, but weight-based energy intake of the tall (at 2 years, 82 [13] kcal/kg) and the obese (79 [17] kcal/kg) were lower than that of children with normal growth (89 [16] kcal/kg). The thin children consumed relatively more energy than the children with normal growth (at 2 years, 94 [13] kcal/kg and 89 [16] kcal/kg, respectively). Parental height and body mass index and the child's absolute and relative energy intakes predicted the best children's growth patterns. Children with consistently low fat intake grew equally to the children with higher fat intake.Conclusions. Moderate supervised restriction of fat intake to values 25 to 30 E% is compatible with normal growth.
Infant Arousals During Mother-Infant Bed Sharing: Implications for Infant Sleep and Sudden Infant Death Syndrome Research
Authors: Mosko Sarah , Richard Christopher , McKenna James 
Published: August 2004

Objective. Normative values for infant sleep architecture have been established exclusively in the solitary sleeping environment. However, most of the world's cultures practice some form of parent-infant cosleeping. In addition, no previous polysomnographic studies in infants examined the frequency of electroencephalogram (EEG) arousals. This is the first study to assess (a) EEG arousals in infants and their relationship to sleep stages; (b) the impact on arousals of mother-infant bed sharing; and (c) the temporal overlap of infant with maternal arousals during bed sharing.Methodology. Three nights of polysomnography were performed in 35 breastfeeding mother-infant pairs when the infants were 11 to 15 weeks old. An adaptation night was followed by one bed sharing night and one solitary sleeping night. Twenty infants had been bed sharing since birth and 15 were routine solitary sleepers. Both epochal awakenings (EWs), based on 30-second epoch scoring of sleep-wake stages, and more transient arousals (TAs) ≥3 seconds were quantified.Results. Stage 3–4 sleep was associated with a striking paucity of EWs and TAs compared with stages 1–2 or rapid eye movement sleep. Bed sharing facilitated EWs and TAs selectively during stage 3–4 sleep. EWs from stage 3–4 sleep were more frequent on the bed sharing night than on the solitary night in both infant groups. Routinely bed sharing infants also exhibited more frequent TAs in stage 3–4 than the routine solitary sleepers in both conditions. In both groups, the number of infant arousals (EWs + TAs) that overlapped the mother's was doubled during bed sharing, with infant arousals leading most often.Conclusions. Mother-infant bed sharing promotes infant arousals. Together with a previous report that bed sharing reduces stage 3–4 sleep, this suggests that normative values for infant sleep must be interpreted within the context of the sleeping environment in which they were established. Given that arousability is diminished in stage 3–4, we speculate that, under otherwise safe conditions, the observed changes in stage 3–4 sleep and arousals associated with bed sharing might be protective to infants at risk for SIDS because of a hypothesized arousal deficit. The responsivity of the mother to infant arousals during bed sharing might also be protective.
War Experiences and Distress Symptoms of Bosnian Children
Authors: Goldstein Richard D. , Wampler Nina S. , Wise Paul H. 
Published: August 2004

Objective. The war in Bosnia has had a tremendous impact on civilians. Little is known about the impact of modern warfare on children. This survey documents the nature and frequency of war-related experiences among Bosnian children and describes their manifestations of selected psychological sequelae.
Methods. A cross-sectional survey of 364 internally displaced 6- to 12-year-old children and their parents living in central Bosnian collectives was conducted during the war. Parents were surveyed for their children's war experiences; the children were surveyed for war-related distress symptoms.
Results. The children were exposed to virtually all of the surveyed war-related experiences. The majority had faced separations from family, bereavement, close contact with war and combat, and extreme deprivation. The prevalence and severity of experiences were not significantly related to a child's gender, wealth, or age, but were related to their region of residence, with children from the region of Sarajevo having the highest prevalence of experiences. Almost 94% of the children met Diagnostic and Statistical Manual of Mental Disorders, 4th ed, criteria for posttraumatic stress disorder. Significant life activity affecting sadness and anxiety were reported by 90.6% and 95.5% of the children, respectively. High levels of other symptoms surveyed were also found. Children with greater symptoms had witnessed the death, injury, or torture of a member of their nuclear family, were older, and came from a large city.
Conclusions. The war-related experiences of the children studied were both varied and severe, and were associated with a variety of psychological sequelae. This experience underscores the vulnerability of civilians in areas of conflict and the need to address the effects of war on the mental health of children.
The Effect of Recombinant Human Growth Hormone in Children With X-Linked Hypophosphatemia
Authors: Seikaly Mouin G. , Brown Richard , Baum Michael 
Published: August 2004

Background. X-linked hypophosphatemia (XLH) is characterized clinically by rickets and growth retardation. Conventional treatment of XLH with oral phosphate and vitamin D fails to normalize linear growth.Objective. To determine the benefit and the potential side effects of recombinant human growth hormone (rhGH) therapy in patients with XLH.Design and Methods. A randomized, double-blind, crossover study was performed throughout a 24-month period in five children with XLH, each patient serving as his own control. The effect of 12 months of rhGH therapy on height, mineral metabolism, glucose and lipid metabolism, hemoglobin, thyroid and parathyroid function, serum 1,25-(OH)2 vitamin D, osteocalcin, growth hormone, urinary calcium, phosphate, nephrocalcinosis, renal function, and bone density was compared with the effects of 12 months of placebo administration on the same parameters.Results. The average age (mean ± SEM) of the patients at the start of the study was 5.6 ± 1.4 years. Growth hormone therapy improved the height standard deviation score (z-score) from a baseline of −2.66 ± 0.21 to −2.02 ± 0.25 and to −1.46 ± 0.28, after 3 and 12 months, respectively. At the start of the control period the heightz-score was −2.27 ± 0.30 compared with −2.22 ± 0.16 after 12 months of placebo administration. The growth velocity standard deviation score was −1.90 ± 0.40 during the 12 months of placebo administration and +4.04 ± 1.50 during the 12 months of rhGH therapy. An increase in serum phosphate from 0.88 ± 0.07 mmol/L to 1.17 ± 0.14 mmol/L and tubular maximum for phosphate reabsorption (TmP/GFR) from 2.12 ± 0.15 to 3.41 ± 0.25 mg/dL, was observed after 3 months of rhGH therapy. However, both serum phosphate and TmP/GFR were unchanged from baseline after 6, 9, and 12 months of rhGH therapy. Neither serum phosphate nor TmP/GFR changed from baseline during the placebo administration. Insulin-like growth factor 1 (IGF-1) increased from 114 ± 25 to 354 ± 51 ng/mL after 12 months of rhGH therapy. Despite the increase in IGF-1 after rhGH therapy, the value did not exceed normal serum concentration. IGF-1 did not change from baseline after 12 months of placebo administration. Neither therapy with rhGH nor with placebo had an effect on glucose and lipid metabolism, hemoglobin, thyroid and parathyroid function, serum 1,25-(OH)2 vitamin D, alkaline phosphatase, osteocalcin, urinary calcium excretion, the grade of nephrocalcinosis, glomerular filtration rate, or urinary albumin excretion. Twelve months of rhGH therapy increased bone mass and width but not density. Twelve months of placebo administration had no effect on bone mass, width, or density.Conclusion. Patients with XLH have an improvement in linear growth and a transient increase in serum phosphate attributable to a transient decrease in urinary phosphate excretion when treated with rhGH.
Oral Rehydration Therapy for Diarrhea: An Example of Reverse Transfer of Technology
Authors: Santosham Mathuram , Keenan Edward Maurice , Tulloch Jim , Broun Denis , Glass Roger 
Published: August 2004

On November 13 and 14, 1996, a scientific symposium on oral rehydration therapy (ORT) was held at the Johns Hopkins University School of Hygiene and Public Health in Baltimore, MD. The purpose of the meeting was to review the current treatment practices for the treatment of this disease in the United States. The group noted that diarrhea resulted in 300 to 400 deaths per year among children, ∼︀200 000 hospitalizations, 1.5 million outpatient visits, and costs &gt;$1 billion in direct medical costs.
ORT is well established therapy for the treatment and prevention of dehydration due to diarrhea. The principles of ORT treatment include early adequate rehydration therapy using an appropriate oral rehydration solution (ORS), replacement of ongoing fluid losses from vomiting and diarrhea with ORS, and frequent feeding of appropriate foods as soon as dehydration is corrected.
The effective use of ORT has saved millions of lives around the world. However, in the United States, ORT is grossly underused. Contrary to the recommendations of the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), health care providers overuse intravenous hydration, prolong rehydration, delay reintroduction of feeding, and inappropriately withhold ORT, especially with children who are vomiting.
The expert panel noted that the majority of deaths, hospitalization, and visits to emergency departments could be prevented by the appropriate use of ORT. They generated guidelines for the treatment and prevention of dehydration secondary to diarrhea. These measures, together with training providers, could substantially reduce diarrhea mortality and decrease hospitalizations of children by 100 000 per year in the next 5 years.