bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congenital Hypothyroidism: Influence of Disease Severity andl-Thyroxine Treatment on Intellectual, Motor, and School-Associated Outcomes in Young Adults
Authors: Oerbeck Beate , Sundet Kjetil , Kase Bengt F. , Heyerdahl Sonja 
Published: August 2004

Objective. To describe intellectual, motor, and school-associated outcome in young adults with early treated congenital hypothyroidism (CH) and to study the association between long-term outcome and CH variables acting at different points in time during early development (CH severity and early l-thyroxine treatment levels [0–6 years]).Methods. Neuropsychological tests were administered to all 49 subjects with CH identified during the first 3 years of the Norwegian neonatal screening program (1979–1981) at a mean age of 20 years and to 41 sibling control subjects (mean age: 21 years).Results. The CH group attained significantly lower scores than control subjects on intellectual, motor, and school-associated tests (total IQ: 102.4 [standard deviation: 13] vs 111.4 [standard deviation: 13]). Twelve (24%) of the 49 CH subjects had not completed senior high school, in contrast to 6% of the control subjects. CH severity (pretreatment serum thyroxine [T4]) correlated primarily with motor tests, whereas early l-thyroxine treatment levels were related to verbal IQ and school-associated tests. In multiple regression analysis, initial l-thyroxine dose (β = 0.32) and mean serum T4 level during the second year (β = 0.48) predicted Verbal IQ, whereas mean serum T4 level during the second year (β = 0.44) predicted Arithmetic.Conclusions. Long-term outcome revealed enduring cognitive and motor deficits in young adults with CH relative to control subjects. Verbal functions and Arithmetic were associated with l-thyroxine treatment variables, suggesting that more optimal treatment might be possible. Motor outcome was associated with CH severity, indicating a prenatal effect.
Adolescent Assault Injury: Risk and Protective Factors and Locations of Contact for Intervention
Authors: Cheng Tina L. , Schwarz Donald , Brenner Ruth A. , Wright Joseph L. , Fields Cheryl B. , O’Donnell Regina , Rhee Peter , Scheidt Peter C. 
Published: August 2004

Background. Violence is a large contributor to morbidity and mortality among adolescents. Most studies assessing markers for violent injury are cross-sectional. To guide intervention, we conducted a case-control study to explore factors associated with assault injury and locations to reach at-risk adolescents.
Objective. 1) To assess risk and protective factors for adolescent assault injury compared with 2 control groups of youth with unintentional injuries and noninjury complaints presenting to the emergency department and 2) to assess locations of contact with assault-injured youth for prevention programs.
Methods. Face-to-face and phone interviews were conducted with systematic samples of youth aged 12 to 19 years presenting to the emergency department with assault injury, unintentional injury, and noninjury complaints. Youth with intentional injuries were matched to youth in the 2 control groups on age ±1 year, gender, race, and residency.
Results. One hundred forty-seven 147 assault-injured youth completed interviews. One hundred thirty-three assault-injured youth were matched to 133 unintentionally injured and 133 noninjured youth presenting to the emergency department. Compared with the 2 control groups, assault-injured youth were more likely to have had more fights in the past year (odds ratio [OR]: 3.91; 95% confidence interval [CI]: 2.02, 7.58; OR: 4.00; 95% CI: 2.23, 7.18) and fights requiring medical treatment (OR: 35.49; 95% CI: 8.71, 144.68; OR: 80.00; 95% CI: 11.13, 574.80). Eighty percent of assault-injured youth had been in 1 or more fights in the last 12 months compared with 55% and 46% in unintentional and noninjured controls, respectively. Assault-injured youth were more likely to have had previous weapon injuries (OR: 9.50; 95% CI: 3.39, 26.6; OR: 8.50; 95% CI: 3.02, 23.95) and have seen someone shot (OR: 2.00; 95% CI 1.12, 3.58; OR: 2.00; 95% CI: 1.12, 3.58). Eighty-six percent of assault-injured youth had a regular health care provider with 82% reporting a visit within the last year. There were no differences between cases and controls with regard to physician contact, extracurricular activity involvement, school or church attendance, police contact, weapon access or weapon-carrying, or witnessing nonweapon-related violence.
Conclusions. Fighting was common among all groups. Assault-injured youth were more likely to have had previous weapon injuries and were high-risk for future injury. Past fights, past fight injuries, and seeing someone else shot were markers associated with assault injury. Health providers do have access to at-risk teens for clinical risk assessment and intervention.
Constipation With Acquired Megarectum in Children With Autism
Authors: Afzal Nadeem , Murch Simon , Thirrupathy Kumran , Berger Leslie , Fagbemi Andrew , Heuschkel Robert 
Published: August 2004

Objective. Recent evidence suggests that autistic children may have significant gastrointestinal symptoms. Although constipation occurs in 2% to 5% of healthy children, its clinical diagnosis is often difficult in children with behavioral disorders. We thus aimed to assess the prevalence of fecal loading in autistic children with gastrointestinal symptoms and to identify possible predictors of constipation.
Methods. We studied abdominal radiographs of 103 autistic children (87 boys) who were referred for gastroenterological assessment, in comparison with 29 control radiographs from children who were referred to the emergency department, most with abdominal pain. Radiographs were scored independently, in blinded manner, by 4 pediatric gastroenterologists and a radiologist. The severity of constipation was determined using a validated index. Details of stool habit, abdominal pain, dietary history, and laxative use were obtained from case notes.
Results. The incidence of constipation in the control subjects with abdominal pain was higher than reported for normal children. Despite this, moderate or severe constipation was more frequent in the autistic group than in the control subjects (36% vs 10%). Analysis of rectosigmoid loading showed more striking differences (54.4% of autistic children had moderate/severe loading or acquired megarectum compared with 24.1% of control subjects). Multivariate regression analysis showed consumption of milk to be the strongest predictor of constipation in the autistic group, whereas stool frequency, gluten consumption, soiling, and abdominal pain were not predictive of constipation.
Conclusions. Constipation is a frequent finding in children with gastrointestinal symptoms and autism, particularly in the rectosigmoid colon, often with acquired megarectum. The absence of any correlation between the clinical history and the degree of fecal impaction in autistic children confirms the importance of an abdominal radiograph in the assessment of their degree of constipation.
School-Age Outcomes in Children Who Were Extremely Low Birth Weight From Four International Population-Based Cohorts
Authors: Saigal Saroj , Ouden Lya den , Wolke Dieter , Hoult Lorraine , Paneth Nigel , Streiner David L. , Whitaker Agnes , Pinto-Martin Jennifer 
Published: August 2004

Objective. The aim of this study was to determine whether learning and school problems in extremely low birth weight (ELBW) and reference children differ between cohorts in different countries.
Methods. Participants were 4 international population-based cohorts of ELBW survivors who were 500 to 1000 g birth weight from New Jersey, central-west Ontario, Bavaria, and Holland (n = 532) and were followed longitudinally from birth. Psychometric data were collected independently and prospectively and included at least 1 measure of cognitive status and 1 measure of achievement administered to the children between the ages of 8 and 11 years. Adjustments were made for comparison of all measures based on reference norms within each country. Information on special educational assistance and grade repetition was obtained from the parents.
Results. The overall follow-up rate was 84% (range: 74%–90%; n = 436). The proportion of children who performed within the normal range (≥85) were as follows: IQ between 44% and 62%; reading between 46% and 81%; arithmetic between 31% and 76%; and spelling between 39% and 65%. Children from New Jersey had the lowest rates of cognitive and achievement deficits, and Bavarian children did less well in achievement scores relative to their peers and other cohorts. Despite these differences, more than half of all cohorts required special educational assistance and/or repeated a grade.
Conclusions. School difficulties were found to be a serious sequelae of ELBW in all 4 countries, an observation that has social and economic implications.
Increasing Immunization Coverage
Authors:   Committee on Community Health Services and Committee on Practice and Ambulatory Medicine
Published: August 2004

Despite many recent advances in vaccine delivery, the goal for universal immunization set in 1977 has not been reached. In 2001, only 77.2% of US toddlers 19 to 35 months of age had received their basic immunization series of 4 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine, 3 doses of inactivated poliovirus vaccine, 1 dose of measles-mumps-rubella (MMR) vaccine, and 3 doses of Haemophilus influenzae type b (Hib) vaccine. Children who are members of a racial or ethnic minority, who are poor, or who live in inner-city or rural areas have lower immunization rates than do children in the general population. Additional challenges to vaccine delivery include the introduction of new childhood vaccines, ensuring a dependable supply of vaccines, bolstering public confidence in vaccine safety, and sufficient compensation for vaccine administration.Recent research has demonstrated specific and practical changes physicians can make to improve their practices’ effectiveness in immunizing children, including the following: 1) sending parent reminders for upcoming visits and recall notices; 2) using prompts during all office visits to remind parents and staff about immunizations needed at that visit; 3) repeatedly measuring practice-wide immunization rates over time as part of a quality improvement effort; and 4) having in place standing orders for registered nurses, physician assistants, and medical assistants to identify opportunities to administer vaccines. Pediatricians should work individually and collectively at local and national levels to ensure that all children receive all childhood immunizations on time. Pediatricians also can proactively communicate with parents to ensure they understand the overall safety and efficacy of vaccines.
Epidemiology of Terror-Related Versus Non-Terror-Related Traumatic Injury in Children
Authors: Aharonson-Daniel Limor , Waisman Yehezkel , Dannon Yehuda L. , Peleg Kobi ,   Members of the Israel Trauma Group
Published: August 2004

Objective. In the past 2 years hundreds of children in Israel have been injured in terrorist attacks. There is a paucity of data on the epidemiology of terror-related trauma in the pediatric population and its effect on the health care system. The objective of this study was to review the accumulated Israeli experience with medical care to young victims of terrorism and to use the knowledge obtained to contribute to the preparedness of medical personnel for future events.
Methods. Data on all patients who were younger than 18 years and were hospitalized from October 1, 2000, to December 31, 2001, for injuries sustained in a terrorist attack were obtained from the Israel National Trauma Registry. The parameters evaluated were patient age and sex, diagnosis, type, mechanism and severity of injury, interhospital transfer, stay in intensive care unit, duration of hospitalization, and need for rehabilitation. Findings were compared with the general pediatric population hospitalized for non-terror-related trauma within the same time period.
Results. During the study period, 138 children were hospitalized for a terror-related injury and 8363 for a non-terror-related injury. The study group was significantly older (mean age: 12.3 years [standard deviation: 5.1] v 6.9 years [standard deviation: 5.3]) and sustained proportionately more penetrating injuries (54% [n = 74] vs 9% [n = 725]). Differences were also noted in the proportion of internal injuries to the torso (11% in the patients with terror-related trauma vs 4% in those with non-terror-related injuries), open wounds to the head (13% vs 6%), and critical injuries (Injury Severity Score of 25+; 25% vs 3%). The study group showed greater use of intensive care unit facilities (33% vs 8% in the comparison group), longer median hospitalization time (5 days vs 2 days), and greater need for rehabilitative care (17% vs 1%).
Conclusions. Terror-related injuries are more severe than non-terror-related injuries and increase the demand for acute care in children.
Fetal Hemoglobin Synthesis Determined by γ-mRNA/γ-mRNA + β-mRNA Quantitation in Infants at Risk for Sudden Infant Death Syndrome Being Monitored at Home for Apnea
Authors: Bard Harry , Côté Aurore , Praud Jean-Paul , Infante-Rivard Claire , Gagnon Carmen 
Published: August 2004

Objective. Fetal hemoglobin (HbF) levels in the hemolysates obtained from infants who died from sudden infant death syndrome (SIDS) are reported to be markedly increased compared with controls. This finding could have been explained by increased HbF synthesis caused by episodes of hypoxemia in the SIDS infants. A prospective study in a group of infants being monitored at home after an apparent life-threatening event (ALTE) and considered at increased risk for SIDS was conducted with an improved ribonuclease protection assay. The ribonuclease protection assay allowed for the quantitation of [γ/(γ+β)]-globin mRNAs, which has a highly significant correlation with the levels of HbF synthesis.Methods. Thirty-five infants who were admitted for an ALTE were included in the study. All infants were at home under surveillance with a cardiorespiratory monitor and followed in an apnea clinic with monthly appointments. Seventy-three blood samples were obtained between 38 and 61 weeks of postconceptional age. For control purposes, a similar group of 37 normal infants (99 samples) whose HbF synthesis was previously determined were included.Results. Mean [γ/(γ+β)]-globin mRNAs were increased in the ALTE group at 42 to 45 and 46 to 49 weeks of postconceptional age (mean: 55.2 ± 17.4% and 33.9 ± 14%) in comparison with HbF synthesis in controls (mean: 42.6 ± 13.7% and 23.6 ± 9.8%).Conclusions. The data obtained in this report from infants who were considered at risk for SIDS show that HbF synthesis is increased between 42 and 49 weeks of postconceptional age. Determining HbF synthesis as described in this study may have value as a marker for episodes of hypoxemia for certain infants who are at risk for SIDS.
Pediatric Viral Human Immunodeficiency Virus Type 1 RNA Levels, Timing of Infection, and Disease Progression in African HIV-1-Infected Children
Authors: Rouet François , Sakarovitch Charlotte , Msellati Philippe , Elenga Narcisse , Montcho Crépin , Viho Ida , Blanche Stéphane , Rouzioux Christine , Dabis François , Leroy Valériane ,   for the Abidjan ANRS 049 Ditrame Study Group
Published: August 2004

Objective. To describe plasma human immunodeficiency virus type 1 (HIV-1) RNA levels in African HIV-1-infected children in relation to the timing of infection and disease progression.
Methods. A retrospective cohort study was conducted of 80 children who were born to HIV-1-positive mothers and clinically followed from birth to 18 months of age in the ANRS 049 Ditrame project, Abidjan, Côte d’Ivoire (West Africa). The diagnosis and timing of pediatric HIV-1 infection were determined prospectively according to HIV-1 DNA polymerase chain reaction results. A total of 364 HIV-1 RNA viral load (VL) measurements were assessed retrospectively. Kaplan-Meier analyses and proportional hazards models were used to evaluate the prognostic value of pediatric VL and covariates for HIV disease progression or death.
Results. Mean initial positive VL was significantly lower among children who were infected in utero (4.94 log10/mL, n = 12) than in children who were infected later (5.6–6.1 log10/mL, n = 68). In the first 6 months after diagnosis, HIV-1 RNA levels peaked (≥6 log10/mL), regardless of timing of infection. Then, a slow decline (overall slope, −0.076 log10 copies/mL/mo) was observed until 18 months of age. A 1 log10 higher value of the pediatric peak VL (risk ratio [RR]: 1.85; 95% confidence interval [CI]: 1.0–3.44) and of the maternal VL at delivery (RR: 1.90; CI: 1.16–3.12) were independently associated with an increased risk of rapid progression to acquired immune deficiency syndrome (AIDS) or death at 18 months of life (23 AIDS diagnoses and 31 deaths). Disease progression or death was more rapid for girls than for boys (RR: 2.26; CI: 1.39–4.96).
Conclusions. In Africa, pediatric HIV-1 RNA levels are very close to those described in industrialized countries and seem to be predictive of AIDS stage or death, as in industrialized countries. With antiretroviral therapy becoming more widely available, the early identification and monitoring of pediatric HIV disease remains of paramount importance in Africa.
A Prospective Study of Bacillus Calmette-Guérin Scar Formation and Tuberculin Skin Test Reactivity in Infants in Lima, Peru
Authors: Santiago Eunice M. , Lawson Elise , Gillenwater Kari , Kalangi Sheela , Lescano Andrés G. , Du Quella Gregory , Cummings Kristin , Cabrera Lilia , Torres Cecilia , Gilman Robert H. 
Published: August 2004

Objectives. To determine the sensitivity of the bacillus Calmette-Guérin (BCG) scar as an indicator of previous vaccination and to ascertain the tuberculin skin test (TST) response in infancy after vaccination in a community from an area hyperendemic for tuberculosis (TB).
Methods. In a birth cohort of healthy term infants from Lima, Peru, a single dose of BCG vaccine was administered within the first month of life. Scar formation was assessed biweekly during the first 6 months and again at 3 years after vaccination. TST response was evaluated 6 months after vaccination.
Results. Six months after vaccination, 99% (68) of the newborns exhibited a BCG scar (&gt;2 mm). Scar size did not differ by sex, birth weight, age at vaccination, or nutritional status in the first 2 months. Eighty percent of the participants were found 3 years after vaccination, and all of them had a BCG scar. Mean TST reaction size 6 months after vaccination was 2.9 ± 0.3 mm. No association was found between sex or age at BCG vaccination and TST size. Only 3 children had a TST &gt;10 mm, and the 3 had a TB contact at home.
Conclusions. The BCG scar was a sensitive indicator of vaccination status up to 3 years after the administration of the vaccine in the first month of life. Although nearly a quarter of the children had a TST response &gt;5 mm 6 months after vaccination, TST reactions &gt;10 mm did not occur in the absence of exposure to a person with tuberculosis. A cutoff of 10 mm should be used for disease control purposes in people who are born in countries where TB is endemic.
Determinants of Nonsynostotic Plagiocephaly: A Case-Control Study
Authors: Hutchison B. Lynne , Thompson John M. D. , Mitchell Ed A. 
Published: August 2004

Objective. There has been a large increase in reported cases of nonsynostotic plagiocephaly in infants since the adoption of supine sleeping recommendations to prevent sudden infant death syndrome. The objective of this study was to identify and quantify the determinants of nonsynostotic plagiocephaly in infants.
Methods. One hundred infants who received a diagnosis of having nonsynostotic plagiocephaly were recruited as case patients and compared with 94 control subjects who were selected from a citywide database of infants. The infants all were aged between 2 and 12 months. Information concerning sociodemographic variables, obstetric factors, infant factors, and infant care practices was obtained by parental interview.
Results. Case patients were significantly more likely to be male (adjusted odds ratio [aOR]: 2.51; 95% confidence interval [CI]: 1.23–5.16), to be a firstborn (aOR: 2.94; 95% CI: 1.46–5.96), and to have been premature (aOR: 3.26; 95% CI: 1.02–10.47). In the first 6 weeks, they were more likely to have been sleeping in the supine position (aOR: 7.02; 95% CI: 2.98–16.53), not to have had the head position varied when put down to sleep (aOR: 7.11; 95% CI: 2.75–18.37), and to have had &lt;5 minutes a day of tummy time (OR: 2.26; 95% CI: 1.03–5.00). Mothers of case patients were more likely to perceive their infants as less active (aOR: 3.23; 95% CI: 1.38–7.56), to have a developmental delay (aOR: 3.32; 95% CI: 1.01–10.85), and to have had a definite preferred head orientation at 6 weeks (aOR: 37.46; 95% CI: 8.44–166.32). Case mothers were more likely to have no or low educational qualifications (aOR: 5.61; 95% CI: 2.02–15.56), although they were more likely to have attended antenatal classes (aOR: 6.61; 95% CI: 1.59–27.47).
Conclusions. Early identification of a preferred head orientation, which may indicate the presence of neck muscle dysfunction, may help prevent the development or further development of nonsynostotic plagiocephaly in infants. Plagiocephaly might also be prevented by varying the head position when putting the very young infant down to sleep and by giving supervised tummy time when awake.