bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immunization Levels and Risk Factors for Low Immunization Coverage Among Private Practices
Authors: Kahane Shellie M. , Watt James P. , Newell Kevin , Kellam Steffi , Wight Suzanne , Smith Natalie J. , Reingold Arthur , Adler Robert 
Published: August 2004

Objectives.Previous studies have indicated that provider characteristics are an important determinant of immunization coverage. The objectives of this study were to: 1) assess immunization coverage levels among 2-year-old children receiving care in private practices in 3 California counties; and 2) evaluate practice and patient risk factors for low immunization coverage.Study Design.Cross-sectional chart review of immunization histories and provider survey of immunization policies.Setting.Forty-five randomly selected, private medical practices in 3 counties in California.Patients.Children 12 to 35 months old, followed by the participating practices.Methods.Providers underwent a detailed assessment of their immunization coverage and completed a questionnaire describing their immunization policies and procedures. Immunization data were abstracted from randomly selected medical charts of children 12 to 35 months old. Only patients who met the criteria for active status (≥2 visits and ≥1 visit during the preceding 18 months) were included in analyses. Immunization coverage levels were calculated and logistic regression was used to estimate the risk of underimmunization associated with different practice and child characteristics.Results.Of the 72 eligible practices that were contacted, 45 participated in the study, yielding a participation rate of 62%. The median immunization coverage of participating offices was 54% (range: 0%–91%). Multivariate analysis revealed 5 independent risk factors for underimmunization. The strongest predictors were having fewer than 50% active children in the practice and children having fewer than 8 visits to the provider. Other significant predictors were the percentage of patients in the practice on Medicaid, administering diphtheria-tetanus-pertussis 4 at a separate visit from the Haemophilus influenzae type b booster, and practice location.Conclusions.These data provide new insights into immunization practices in an important clinical setting that has been poorly characterized previously. Immunization coverage levels were found to be low and significant risk factors for underimmunization were identified. Recommendations are made for immunization policy changes and targeting of immunization improvement interventions at practices that may be at risk for low immunization coverage. immunization, vaccination, immunization programs, primary prevention, private practice, child, preschool, pediatrics, family practice.
Initial Intravenous Gammaglobulin Treatment Failure in Kawasaki Disease
Authors: Wallace Carol A. , French James W. , Kahn Stuart J. , Sherry David D. 
Published: August 2004

Objectives.To determine initial intravenous gammaglobulin (IVIG) treatment failures in Kawasaki disease (KD) and to report the outcome of retreatment and our use of pulse intravenous (IV) methylprednisolone and cyclophosphamide in patients with persistent KD.Study Design.Retrospective analysis of the treatment and response of children with KD over 3 years.Results.Fifty (77%) of 65 patients completely responded to a single treatment with IVIG (2 g/kg). Fifteen patients (23%) required retreatment; 10 patients fully responded but 5 had persistent disease (3 developed coronary aneurysms and 4 developed coronary artery thrombosis). Four of these 5 patients with persistent disease were treated with pulse IV methylprednisolone and 2 were also treated with IV cyclophosphamide. There was no progression of coronary aneurysms and no deaths. No initial patient characteristics predicted IVIG treatment failure or the development of coronary aneurysms.Conclusion.Nearly 23% of patients with KD may require retreatment and 8% may develop coronary aneurysm. Additional antiinflammatory therapy, such as IV methylprednisolone and IV cyclophosphamide, may be helpful in treating persistent KD.
Skin Barrier Properties in Different Body Areas in Neonates
Authors: Yosipovitch Gil , Maayan-Metzger Ayala , Merlob Paul , Sirota Lea 
Published: August 2004

Objective.The aim of the study was to investigate skin barrier function in neonates in different anatomic sites during the first 2 days of life.Design.The study population consisted of 44 healthy full-term newborn infants. Transepidermal water loss (TEWL), stratum corneum hydration (SCH), and skin surface pH were measured in different anatomic sites (forehead, flexor part of forearm, upper back, abdomen, inguinal region, palms, and soles) during the first 10 hours of life and 24 hours later. Measurements were recorded with a Tevameter, a Corneometer, and a skin pH meter with a flat glass electrode. Results were compared with those in 20 healthy adults.Results.TEWL was lower in infants than in adults in the forehead, palms, soles, and higher in the forearms. It was significantly higher on day 1 than on day 2 in the soles, palms, and forearms, and in the forearm, palms, and inguinal region compared with the other anatomic sites. SCH was significantly lower in the infants on the forehead, back, and abdomen, and higher on the forearms and palms; it was significantly higher on the first day of life on the forearms and palms, and lower in the inguinal region. Skin surface pH was significantly higher in the infants in all body sites (&gt;6.6 in most measurements). On day 2, it was significantly lower than on day 1, but still higher than in adults. SCH correlated positively with TEWL in the neonates but not in the adults. None of the variables were related to gestational age, sex, mode of delivery, or body weight.Conclusions.Changes take place in SCH, water loss, and pH in the first 2 days after birth, suggesting that the stratum corneum barrier is still in the process of adapting to extrauterine life. The significant anatomic variability in TEWL and SCH should be taken into account in evaluating the permeation of skin care products and topical medications in newborns.
Accuracy of Teen and Parental Reports of Obesity and Body Mass Index
Authors: Goodman Elizabeth , Hinden Beth R. , Khandelwal Seema 
Published: August 2004

Objectives.
Adolescent obesity is becoming an increasing public health problem. This study determines: 1) differences in teen and parental report of obesity, 2) amount of misclassification using body mass index (BMI) from self-reported versus measured height and weight as an indicator of obesity, and 3) whether misclassification varies by gender and socioeconomic status.

Design.
Weighted data from 15 483 baseline (T1) youth and parental interviews from the National Longitudinal Study of Adolescent Health were used. Seventy-four percent of teens were reinterviewed 1 year later (T2). Parents reported socioeconomic status indicators and whether their teen was obese. Teens reported height, weight, and weight perception. BMI was calculated from both self-reported height and weight at T1 and T2 and from measured height and weight at T2. Those with a BMI ≥95% corrected for age and gender were considered obese.

Results.
At T1, nearly one half of teens (47%) reporting they were very overweight were not obese by BMI. For teens obese by BMI, 19.6% were reported to be obese by both parent and teen, 6.4% by teen only, 29.9% by parent only, and 44.2% by neither teen nor parent. For those with persistent obesity, teen and/or parental report failed to identify more than one third (34%) as obese; 23.4% were identified by both teen and parent report, 5.4% by teen report only, and 37.2% by parent only. At T2, the correlation between BMI calculated from self-reported versus measured height and weight for the overall population was very strong (r = .92). Specificity of obesity status based on self-reported BMI, compared with obesity status based on measured BMI was .996; sensitivity, .722; positive predictive value, .860; and negative predictive value, .978. Overall, 3.8% of teens were misclassified using self-report measures. Girls were no more likely than boys to be misclassified as obese using BMI from self-reported height and weight.

Conclusions.
Parental report is a better indicator of obesity than teen report of weight status, but parental and teen reports are both poor predictors of adolescent obesity. Using BMI based on self-reported height and weight correctly classified 96% as to obesity status. Thus, studies can use self-reported height and weight to understand teen obesity and its correlates/sequelae.
Development of Parasomnias From Childhood to Early Adolescence
Authors: Laberge Luc , Tremblay Richard E. , Vitaro Frank , Montplaisir Jacques , PhD CRCP(c), 
Published: August 2004

Objectives.This study examines the prevalence and developmental changes of parasomnias and assesses gender differences, relationships between parasomnias, and associations with anxiety and family adversity using data collected during the course of a longitudinal study of a representative sample of children from Québec.Method.The present analyses are based on results available for 664 boys and 689 girls for whom mothers have completed questions concerning demographics, parasomnias, and anxiety level. For the prevalence and developmental aspects of parasomnias, prospective data were collected at annual intervals from 11 to 13 years old and retrospective data for the period between ages 3 and 10 years were collected when the children were 10 years old.Results.Somniloquy, leg restlessness, and sleep bruxism are the most frequent parasomnias. More girls were afflicted with leg restlessness, while enuresis and somniloquy were more common in boys. High anxiety scores were found in children suffering from night terrors, somniloquy, leg restlessness, sleep bruxism, and body rocking. Parasomnias were unrelated to the index of family adversity.Conclusions.Although sleepwalking, night terrors, enuresis, and body rocking dramatically decreased during childhood, somniloquy, leg restlessness, and sleep bruxism were still highly prevalent at age 13 years, paralleling results found in adults. Sleepwalking, night terrors, and somniloquy are conditions often found together. The only robust gender difference was for enuresis. High anxiety scores in parasomnias are reported for the first time in a large, controlled study. Sociodemographic variables do not seem to play a major role in the occurrence of parasomnias.
Pediatric Tuberculosis: What Needs to be Done to Decrease Morbidity and Mortality
Authors: Heymann S. Jody , Brewer Timothy F. , Wilson Mary E. , Colditz Graham A. , Fineberg Harvey V. 
Published: August 2004

Objective.Tuberculosis (TB) control programs have been less successful among children than among adults in the United States. Between 1992 and 1997, the rate of decline of TB cases among 0- to 14-year-old children was less than the rate of decline among any other age group of US-born persons. Because of the higher prevalence of active TB among adults and their higher infectivity, most programs for TB in the United States have targeted adults. The inherent assumption has been that by targeting adults, from whom children may become infected, TB morbidity and mortality among children also will be reduced effectively.Methods.Using a semi-Markov model that divided the US population into age groups &lt;15 years old and ≥15 years old and into 18 clinical states based on the risk for or presence of TB and human immunodeficiency virus infection, we developed a computer-based simulation model to examine the effect of a range of potential TB control strategies on projected TB cases and deaths in children. We compare the impact of interventions targeted at children with the impact of interventions targeted at adults on pediatric morbidity and mortality.Results.After 10 years, a 5% increase in the number of adults with TB who enter treatment would only lead to a .05% decline in TB cases among children, compared with predicted cases without this intervention. Improving treatment efficacy among those adults who are already receiving treatment for their TB leads to a smaller decline in cases among children of only .003%. In contrast, a 5% increase in the number of children who enter treatment leads to a 25% decline, after 10 years, in the number of TB cases among children and a 16% decline in the number of TB deaths. In the presence of immigration of tuberculin-positive children, the benefit of targeting programs directly at children is magnified.Conclusions.Marginal changes in programs targeted directly at children are significantly more effective at further reducing pediatric TB morbidity and mortality than the same changes in programs targeted at adults with the indirect goal of reducing spread to children.Marginal increases in the number of children who enter treatment are far more effective at decreasing morbidity and mortality than equivalent marginal increases in treatment effectiveness. Unfortunately, declining insurance coverage and increasing restrictions on services to immigrants have made it harder for those who are at greatest risk of TB to get medical care. Marginal increases in preventive therapy rates substantially reduce future pediatric TB cases and deaths among children with TB infection and human immunodeficiency virus.
Adverse Childhood Experiences and Sexually Transmitted Diseases in Men and Women: A Retrospective Study
Authors: Hillis Susan D. , Anda Robert F. , Felitti Vincent J. , Nordenberg Dale , Marchbanks Polly A. 
Published: August 2004

Objective.
Adverse childhood experiences (ACEs) may have long-term consequences on at-risk behaviors that lead to an increased risk of sexually transmitted diseases (STDs) during adulthood. Therefore, we examined the relationship between ACEs and subsequent STDs for both men and women.

Methods.
A total of 9323 (4263 men and 5060 women) adults ≥18 years of age participated in a retrospective cohort study evaluating the association between ACEs and self-reported STDs. Participants were adult members of a managed care organization who underwent routine medical evaluations and completed standardized questionnaires about 7 categories of ACEs, including emotional, physical, or sexual abuse; living with a battered mother; and living with a substance-abusing, mentally ill, or criminal household member. Logistic regression was used to model the association between the cumulative categories of ACEs (range: 0–7) and a history of STDs.

Results.
We found that 59% (2986) of women and 57% (2464) of men reported 1 or more categories of adverse experiences during childhood. Among those with 0, 1, 2, 3, 4 to 5, and 6 to 7 ACEs, the proportion with STDs was 4.1%, 6.9%, 8.0%, 11.6%, 13.5%, and 20.7% for women and 7.3%, 10.9%, 12.9%, 17.1%, 17.1%, and 39.1% for men. After adjustment for age and race, all odds ratios for reporting an STD had confidence intervals that excluded 1. Among those with 1, 2, 3, 4 to 5, and 6 to 7 ACEs, the odds ratios were 1.45, 1.54, 2.22, 2.48, and 3.40 for women and 1.46, 1.67, 2.16, 2.07, and 5.3 for men.

Conclusions.
We observed a strong graded relationship between ACEs and a self-reported history of STDs among adults.
Infectious Disease Challenges in Immigrants From Tropical Countries
Authors: Worley Clyde Walter , Worley Kimberly Ann , Kumar P. Lucy 
Published: August 2004

Background.
In today's mobile society, international travel and immigration are becoming increasingly more common. This poses an additional challenge to the clinician to expand the differential diagnosis to include diseases endemic to the area of travel.

Observation.
We present a case of malaria and tuberculosis in a 16-year-old African male immigrant. He had several encounters with the health care system for complaints of nonspecific symptoms for which he was treated with antibiotics without follow-up.

Conclusion.
Clinicians should take a complete history and expand their differential diagnosis to include diseases endemic to the country of origin and/or travel when treating an international patient. This not only will allow prompt treatment of the patient's condition but also will address public health concerns.
The False-Positive in Universal Newborn Hearing Screening
Authors: Clemens Conrad J. , Davis Sherri A. , Bailey Andrea R. 
Published: August 2004

Objectives.Concern has been raised about the frequency and subsequent emotional effect of a false-positive result during universal newborn hearing screening (UNHS). This study describes: 1) the results of 1 UNHS program and a potential method to significantly reduce the false-positive rate, and 2) the effect a false-positive result has on lasting maternal anxiety toward their children as well as their views toward UNHS in general.Methods.A retrospective analysis was conducted using data from 5010 infants screened with an automated auditory brainstem response (ABR) at the Women's Hospital of Greensboro (WHOG) from July 6, 1998 to June 30, 1999. In addition, a structured telephone survey was given to mothers of infants who had failed the initial hearing screen (stage 1) and who had completed an outpatient rescreen (stage 2).Results.Confirmed hearing loss occurred in non-neonatal intensive care unit infants at a rate of 1.8/1000. A false-positive rate of 1.9% occurred during stage 1 of UNHS (screening before newborn discharge). We attribute this relatively low rate to rescreening of 51% of those newborns who failed the initial screen before hospital discharge. Eighty percent of these rescreened infants passed, thus needing no additional follow-up. If we had rescreened all infants before discharge, the false-positive rate would have approached .5%.Results of the survey were reassuring with regard to lasting emotional effects of false-positive tests. Only 9% of mothers said they “treated their child differently” before outpatient rescreening, and only 14% reported any lasting anxiety after their child passed the outpatient repeat screen. Although none reached statistical significance, potential risk factors for lasting anxiety include more educated mothers, lack of understanding of UNHS, and a false-positive result in both stage 1 and stage 2. Over 90% of all mothers believed that UNHS was a good idea.Conclusions.By rescreening all infants before hospital discharge, the false-positive rate of UNHS performed using automated ABR can be reduced to &lt;1%. However, for the false-positive results that do occur, any long-lasting and detrimental emotional impact between mother and infant seems to be small and could be reduced even more with improved understanding about UNHS.
The Effect of Inhaled Steroids on the Linear Growth of Children With Asthma: A Meta-analysis
Authors: Sharek Paul J. , Bergman David A. 
Published: August 2004

Objective.To determine whether inhaled steroid therapy causes delayed linear growth in children with asthma.Data Sources.Medline (1966–1998), Embase (1980–1998), and Cinahl (1982–1998) databases and bibliographies of included studies were searched for randomized, controlled trials of inhaled steroid therapy in children with asthma that evaluated linear growth.Study Selection.Studies were included if they met the following criteria: subjects 0 to 18 years of age with the clinical diagnosis of asthma; subjects randomized to inhaled beclomethasone, budesonide, flunisolide, fluticasone, or triamcinolone versus a nonsteroidal inhaled control for a minimum of 3 months; single- or double-blind; and outcome convertible to linear growth velocity. English- and non–English-language trials were included.Data Extraction.Data were extracted using a priori guidelines. Methodologic quality was assessed independently by both authors. Outcome was extracted as linear growth velocity.Results.Included trials were subgrouped by inhaled steroid. The beclomethasone subgroup, with 4 studies and 450 subjects, showed a decrease in linear growth velocity of 1.51 cm/year (95% confidence interval: 1.15,1.87). The fluticasone subgroup, with 1 study and 183 subjects, showed a decrease in linear growth velocity of .43 cm/year (95% confidence interval: .01,.85). Sensitivity analysis in the beclomethasone subgroup, which evaluated study quality, mode of medication delivery, control medication, and statistical model, showed similar results.Conclusions.This meta-analysis suggests that moderate doses of beclomethasone and fluticasone in children with mild to moderate asthma cause a decrease in linear growth velocity of 1.51 cm/year and .43 cm/year, respectively. The effects of inhaled steroids when given for &gt;54 weeks, or on final adult height, remain unknown.
Pain Experience of Children With Headache and Their Families: A Controlled Study
Authors: Aromaa Minna , Sillanpää Matti , Rautava Päivi , Helenius Hans 
Published: August 2004

Objective.This study reports the pain sensitivity of children with headache and their family members, as well as the prevalence of recurring aches, psychosocial life, and family environment of children with headache at preschool age.Design.A representative population-based sample of 1443 families expecting their first child were followed over 7 years. A screening questionnaire relating to the child's headache was sent to parents of a representative sample of 1132 6-year-old children. Of 144 children suffering from headache, 106 (76%) were examined and interviewed clinically. Ninety-six children with primary headache (58 migraine and 38 tension-type headache children) and matched controls (n = 96) were included in further examinations.Results.Children with headache were more often extremely sensitive to pain according to their parents, were more excited about physical examinations, cried more often during blood sampling or vaccination, avoided play or games more often because they were afraid of hurting themselves, and had recurring abdominal and growing pains more often than did control children. The fathers of children with headache were more often extremely sensitive to pain. Children with headache reacted with somatic symptoms, usually with pain and functional intestinal disorders in stress situations, felt more tired, and had more ideations of death during the previous month. They had also had more problems in day care and fewer hobbies such as scout or club meetings than did control children.More mothers of tension-type headache children than those of migraine children reported that they were considerably sensitive to pain. Tension-type headache children also had a poorer family environment; the family atmosphere was more often unhappy and the relationship between the parents was more often distant than in the families of children with migraines.Conclusions.In addition to somatic factors, it is important to consider the child's pain sensitivity, reaction to various stress situations, and family functioning when studying childhood headache. The child's coping mechanisms can be supported by information given by the parents. School entry can be considered a suitable period for careful investigation into possible occurrence of headache and also for giving information about headache and its management.