bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Young Children in Contact With Adult Multidrug-Resistant Pulmonary Tuberculosis: A 30-Month Follow-up
Authors: Schaaf H. Simon , Gie Robert P. , Kennedy Magdalene , Beyers Nulda , Hesseling Peter B. , Donald Peter R. 
Published: August 2004

Setting. The Western Cape Province of South Africa, an area with a high tuberculosis (TB) incidence, where initial multidrug resistance (MDR) among adult TB cases was 1.1% during 1992–1993.
Objective. To determine the long-term prevalence of TB infection and disease in children in household contact with adults with MDR pulmonary TB, and to establish the efficacy of chemoprophylaxis in preventing disease in these children.
Method. Children &lt;5 years old in contact with 73 MDR TB adults were evaluated. Disease was treated by prescribing at least 2 drugs to which the adult’s strain was susceptible. The remaining children were classified as infected or noninfected and received chemoprophylaxis according to the index’s strain susceptibility or were followed up and treated when indicated. All were followed up for 30 months.
Results. At the initial evaluation 125 children were seen, median age 27.5 months. Of these, 119 were followed up. Fourteen (12%) had disease, 61 (51%) were infected only, and 44 (37%) were noninfected. By 30-month follow-up, 29 (24%) had developed disease and 64 (54%) were infected only. Four adult-child pair Mycobacterium tuberculosis isolates were compared by DNA fingerprinting; 3 were identical. All children who developed TB disease were clinically cured. Two (5%) of 41 children who received appropriate chemoprophylaxis and 13 (20%) of 64 who did not, developed TB during follow-up (odds ratio: 4.97).
Conclusion. The study confirms MDR TB transmission to childhood contacts. Seventy-eight percent of children were infected or developed disease. Appropriate chemoprophylaxis may prevent disease in these children.
Comparison Between Simultaneously Recorded Amplitude Integrated Electroencephalogram (Cerebral Function Monitor) and Standard Electroencephalogram in Neonates
Authors: Toet Mona C. , van der Meij Wil , de Vries Linda S. , Uiterwaal Cuno S. P. M. , van Huffelen Kees C. 
Published: August 2004

Objective: To assess the value and the limitations of amplitude integrated electroencephalogram (EEG) using the cerebral function monitor (CFM) in comparison with standard EEG in neonates who have hypoxic ischemic encephalopathy or were suspected of having convulsions.
Methods. In 36 neonates with a gestational age ≥36 weeks, CFM and simultaneously recorded EEG traces were analyzed off-line and independently classified. CFM background activity: continuous normal voltage; continuous normal voltage, slightly discontinuous (DNV); burst-suppression (BS); continuous extremely low voltage; flat tracing. CFM epileptiform activity: suspected epileptic activity, single seizure (SS), repetitive seizures (RS), status epilepticus (SE). EEG background activity: normal, depressed, low voltage undifferentiated, excessive discontinuity, BS, no activity. Epileptiform activity: interictal unifocal, interictal multifocal, ictal unifocal, ictal multifocal, SE.
Results. A total of 33 traces were suitable for analysis. Interobserver agreement on background activity was reached in 31 cases (κ = 0.92) for CFM and in 27 cases (κ = 0.74) for EEG. There was full agreement on CFM ictal activity (RS, SS, or SE) and EEG ictal activity. A normal CFM (continuous normal voltage) corresponded with a normal or a depressed EEG in 90% of the cases. The positive predictive value for a severely abnormal CFM (BS, continuous extremely low voltage, flat tracing) to correspond with a severely abnormal EEG (excessive discontinuity, BS, low voltage undifferentiated, no activity) was 100% (negative predictive value, 80%; sensitivity, 76%; specificity, 100%). DNV (10) on CFM corresponded either with depressed (6) or excessive discontinuity (4) on EEG. Ictal activity on EEG corresponded with SS, RS, or SE on CFM in 8 cases (sensitivity, 80%; specificity, 100%; positive predictive value, 100%; negative predictive value, 92%).
Conclusion. CFM is a reliable tool for monitoring both background patterns (especially normal and severely abnormal) and ictal activity. Certain focal, low amplitude, and very short periods of seizure discharges can be missed. We recommend using CFM as a monitoring device and performing intermittent standard EEG whenever there is any doubt about the classification of the CFM (ie, DNV pattern or suspected epileptiform activity).
Efficacy of the Ketogenic Diet for Infantile Spasms
Authors: Kossoff Eric H. , Pyzik Paula L. , McGrogan Jane R. , Vining Eileen P. G. , Freeman John M. 
Published: August 2004

Objective. The objective of this study was to determine whether the ketogenic diet is safe, well-tolerated, and efficacious in the treatment of infantile spasms.Methods. During a 4-year period, 23 children with infantile spasms, aged 5 months to 2 years, were started on the ketogenic diet; 9 (39%) had symptomatic infantile spasms, and 16 (70%) had hypsarrhythmia. Children had an average prediet exposure to 3.3 anticonvulsants. Two children were enrolled before any medication had been tried. Seizure reduction was analyzed retrospectively, using parent reports and electroencephalograms (EEGs) when available.Results. At 3, 6, 9, and 12 months, 38%, 39%, 53%, and 46%, respectively, of all patients currently on the diet were &gt;90% improved (3 were seizure-free at 12 months); 67%, 72%, 93%, and 100% were &gt;50% improved. Fifty-six percent remained on the diet at 12 months, 46% of whom were &gt;90% improved and 100% were &gt;50%. Fifty percent of those with hypsarrhythmia and follow-up EEGs had EEG improvement. Fifty-seven percent had their medications reduced or discontinued by 12 months. Fifty-seven percent had improvement in development, which was correlated with seizure control. Independent factors that predicted improvement included age younger than 1 year and previous exposure to 3 or fewer anticonvulsants. No child has died, and 7 children had diet-related adverse reactions (nephrolithiasis, gastroesophageal reflux).Discussion. The ketogenic diet is a safe, well-tolerated, and possibly effective potential alternative to other therapies for infantile spasms.
Caffeine Impairs Cerebral and Intestinal Blood Flow Velocity in Preterm Infants
Authors: Hoecker Christina , Nelle Mathias , Poeschl Johannes , Beedgen Bernd , Linderkamp Otwin 
Published: August 2004

Objective. In adults, a single dose of 250 mg of caffeine may decrease cerebral blood flow by 30%. In preterm infants, caffeine is commonly used for the treatment and prophylaxis of apnea. The purpose of this investigation was to assess effects of caffeine on circulatory parameters in preterm infants.
Methods. We studied 16 preterm neonates with a mean gestational age (mean ± standard deviation) of 31 ± 1.2 weeks (range: 29–33 weeks), birth weight of 1400 ± 380 g (range: 625-2060 g), and postnatal age of 24 to 72 hours before and 1 and 2 hours after an oral loading dose of 25 mg/kg pure caffeine. We investigated left ventricular output (LVO), cerebral blood flow velocity (BFV) of the internal carotid artery (ICA) and the anterior cerebral artery, and intestinal BFV of the celiac artery and superior mesenteric artery by Doppler sonography.
Results. Mean BFV in the ICA decreased significantly 1 (17%) and 2 hours (22%) after caffeine administration. Mean BFV in the anterior cerebral artery showed a reduction of 14% after 2 hours. The mean BFV in the superior mesenteric artery decreased significantly 1 and 2 hours after caffeine administration (30%). Mean BFV in the celiac artery showed a significant reduction of 14% 1 hour after caffeine. No changes were observed in LVO, blood pressure, and heart rate.
Conclusion. Oral administration of a high loading dose of caffeine results in marked reduction of cerebral and intestinal BFV, without changing LVO, blood pressure, and heart rate.
Demography of Pediatric Primary Care in Europe: Delivery of Care and Training
Authors: Katz Manuel , Rubino Armido , Collier Jacqueline , Rosen Joel , Ehrich Jochen H. H. 
Published: August 2004

Objective. The Union of National European Pediatric Societies and Associations recognized the lack of information regarding demography of delivery of care and training for the doctors who care for children in Europe. Therefore, the Union of National European Pediatric Societies and Associations studied factors and explanations for the variation between countries regarding pediatric primary care (PPC) and community pediatrics (CP) as well as the extent of formal training provided for those who take care of children at the community level.
Methods. An explanatory letter and a questionnaire with 12 questions regarding delivery of PPC and CP and training was mailed to the president of each of 41 national pediatric societies in Europe. Statistical data about population, country’s income, and infant mortality rate (IMR) were also obtained from World Health Organization data. Statistical analysis using multivariate and linear regression was conducted to ascertain which variables were associated with IMR. Descriptive statistics regarding demography and training are also reported.
Results. In 1999, a total of 167 444 pediatricians served a population of 158 million children who were younger than 15 years and living in the 34 reporting European countries. The median number of children per pediatrician was 2094; this varied from 401 to 15 150. A pediatric system for PPC existed in 12 countries; 6 countries had a general practitioner system, and a combined system was reported from 16 countries. Pediatricians did not work at the primary care level at all in 3 countries. In 14 of 34 countries, pediatricians worked in various aspects of community medicine, such as developmental pediatrics, well-infant care, school physicians, and so forth. IMR was lower in countries with a higher income per capita. In addition, a pediatric system of primary care had a protective effect when looking at IMR as the outcome. In 75% of the countries, some form of training in pediatric care for pediatricians was reported; the corresponding data for general practitioners was 60%. Community-based teaching programs were offered to pediatricians and general practitioners in a minority of countries only.
Conclusions. At the end of the century, Europe showed a considerable variation in both delivery of PPC and training for doctors who care for children. This study identified 3 different health care delivery systems for PPC, as well as 2 types of pediatricians who work in community-based settings. Formal training in PPC or CP for both pediatricians and general practitioners varied from established curricula to no teaching at all. Economic and sociopolitical issues, professional power, and geographical and historical factors may explain the differences in pediatric care among European countries.
Association Between Infantile Colic and Carbohydrate Malabsorption From Fruit Juices in Infancy
Authors: Duro Debora , Rising Russell , Cedillo Maribel , Lifshitz Fima 
Published: August 2004

Objective. To determine whether infantile colic (IC) is associated with malabsorption of carbohydrates present in fruit juices.Methods. In this double-blind study, parents of 30 healthy infants (5.1 ± 0.7 months, 7.4 ± 1.0 kg, 64 ± 4 cm) were administered a questionnaire to quantitatively assess IC. Thereafter, they were divided into 2 groups, 16 infants with and 14 without IC. Within each treatment group infants were fed 120 mL (16.3 ± 2.0 mL/kg) of either white grape (sorbitol-free; 1:1 fructose-to-glucose ratio) or apple (sorbitol 0.5 g/dL; 2.6:1 fructose-to-glucose ratio) juice. Physical activity (PA), energy expenditure (EE), crying, and sleeping times were measured for 0.5 and 3.0 hours before and after juice feeding, respectively, using the Enhanced Metabolic Testing Activity Chamber. Carbohydrate malabsorption was determined by breath hydrogen (BH2) gas analysis after juice feedings. Statistical differences between groups were determined by 2-way analysis of variance with the Tukey procedure.Results. Infants with IC fed apple juice exhibited carbohydrate malabsorption as shown by increased BH2 excretion, whereas those without IC absorbed carbohydrates normally when fed this juice. Infants fed apple juice with carbohydrate malabsorption cried more and consequently slept less during the last 1.5 hours of the study. This was associated with increased PA and EE as compared with infants without IC fed apple juice. In contrast, infants fed white grape juice, regardless of IC, showed no increase in BH2 excretion, PA, and EE. Furthermore, crying and sleeping times were unchanged in infants fed white grape juice regardless of the presence or absence of IC.Conclusions. IC was associated with carbohydrate malabsorption from fruit juices containing sorbitol and a high fructose-to-glucose ratio.
Assent Observed: Children’s Involvement in Leukemia Treatment and Research Discussions
Authors: Olechnowicz Joseph Quinn , Eder Michelle , Simon Christian , Zyzanski Stephen , Kodish Eric 
Published: August 2004

Objective. Assent is a critical issue in pediatric ethics that has not been well-studied. We examined the role of older children in discussing a recent diagnosis of acute leukemia and treatment options, including participation in a randomized, clinical trial (RCT).
Design. Our sample was drawn from data collected as part of a larger, National Cancer Institute-funded study in which we observed, tape-recorded, and transcribed the informed consent conference (ICC) for children with leukemia at 6 institutions. We analyzed the data for the child’s presence and role, examined 5 discussion categories relevant to assent in the context of pediatric cancer treatment/research, conducted parent interviews, and administered clinician questionnaires to examine these issues. We report a qualitative analysis of 14 cases in which the child was present for the ICC.
Results. Clinicians varied with regard to whom they directed specific discussions when patients were present. Questions asked by the children predominantly related to details of the disease and treatment, with few questions about the RCT. Clinicians and parents attribute responsibility for decision-making about participation in RCTs in a variety of ways. In conferences that included the child-patient, parents asked significantly fewer questions than in other ICCs.
Conclusion. There is significant variation among ICCs that include the older child. Additional empirical study of assent is warranted, and our data suggest several hypotheses that should be tested in future research.
Validity of Maternal Report of Prenatal Alcohol, Cocaine, and Smoking in Relation to Neurobehavioral Outcome
Authors: Jacobson Sandra W. , Chiodo Lisa M. , Sokol Robert J. , Jacobson Joseph L. 
Published: August 2004

Objective. Evidence that mothers report higher levels of drinking retrospectively than during pregnancy has led some investigators to suggest that women systematically underreport alcohol antenatally and that alcohol-related deficits may actually reflect heavier prenatal exposure. This study is the first to compare the validity of antenatal and retrospective reports of pregnancy drinking, drug use, and smoking in relation to effects on infant neurobehavioral outcomes.Methodology. Three hundred fifty-four inner-city mothers were interviewed regarding their alcohol, drug use, and smoking during pregnancy and retrospectively at 13 months’ postpartum. Their infants were assessed at 6.5, 12, and 13 months on a large battery of neurobehavioral assessments.Results. Although higher levels of alcohol were reported retrospectively, the correlations of prenatal alcohol exposure with infant outcome were as strong or stronger for the antenatal measures and only the antenatal reports predicted poorer cognitive performance on the Bayley Scales and symbolic play, slower processing speed on the Fagan Test of Infant Intelligence and cross-modal transfer, and slower infant reaction time. Women also reported higher levels of cocaine and marijuana but not cigarette smoking retrospectively. Relations between cocaine use and smoking on birth size and gestational age were as strong for either report. No effects were detected in relation to either report of marijuana use during pregnancy.Conclusions. These findings suggest that antenatal alcohol interviews provide the most valid information and demonstrate the importance of assessing prenatal alcohol use during pregnancy to minimize the risk of failing to detect neurobehavioral deficits. Adverse effects were consistently seen at levels as low as 0.5 oz absolute alcohol/day (the equivalent of 7 drinks per week) based on maternal antenatal report. These data suggest that alcohol-related deficits do not reflect heavier prenatal exposure than that reported during pregnancy and that threshold values derived from antenatal reports are reasonably accurate.
Viral Respiratory Infection in Schoolchildren: Effects on Middle Ear Pressure
Authors: Winther Birgit , Hayden Frederick G. , Arruda Eurico , Dutkowski Regina , Ward Penelope , Hendley J. Owen 
Published: August 2004

Objective. To evaluate the effect of uncomplicated viral respiratory infections (colds) on middle ear pressure in healthy school-aged children.Methods. Children (ages 2–12) with normal tympanograms before onset of illness had bilateral tympanometry daily except weekends for 2 weeks after the onset of a cold. Nasopharyngeal secretion obtained at onset of illness was cultured for bacterial pathogens of otitis media using selective agars and tested for rhinovirus, coronavirus, respiratory syncytial virus, influenza A and B, and parainfluenza 1–3 by reverse transcriptase polymerase chain reaction technology. Tympanometry was designated as abnormal with peak pressure of ≤−100 daPa or ≥50 daPa and/or a compliance peak of &lt;0.2 cm3.Results. Eighty-six colds were studied, 82 in schoolchildren (5–12 years old) and 4 in 2- to 3-year-olds. Abnormal negative middle ear pressure occurred at least once during the 2 weeks after onset in 57 (66%) of the 86 colds. Tympanometry was abnormal in the first week after onset in 50 (88%) of the 57 colds and was abnormal on a single day in 17 (30%) of the 57. The middle ear pressure abnormalities were intermittent and shifted from one ear to the other ear from day to day. Reverse transcriptase polymerase chain reaction was positive for a respiratory virus in 56 (65%) of the 86 illnesses. Rhinovirus was found in 48% and respiratory syncytial virus in 14%. Pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis) were detected in nasopharyngeal secretion in 29 (34%) of the 86 colds; the bacteria were in high titer (≥103 cfu/mL) in 26 of the 29 positive specimens. None developed illness that required a visit to a physician.Age, detection of a respiratory virus, and presence of bacterial pathogen in the nasopharyngeal secretion had a negligible effect on the occurrence of abnormal tympanometry. Occurrence of negative middle ear pressure in winter-spring colds was significantly greater than in fall colds for unexplained reasons.Conclusions. Transient negative middle ear pressure occurred in two thirds of uncomplicated colds in healthy children. This negative pressure, which may facilitate secondary viral or bacterial otitis media, seems to result from viral infection of the nasopharynx and distal tube causing bilateral eustachian tube dysfunction. Tympanometry provides an objective measure of the potential beneficial effects of investigational treatments on the risk of eustachian tube dysfunction/otitis media.
Occurrence of Celiac Disease After Onset of Type 1 Diabetes: A 6-Year Prospective Longitudinal Study
Authors: Barera Graziano , Bonfanti Riccardo , Viscardi Matteo , Bazzigaluppi Elena , Calori Giliola , Meschi Franco , Bianchi Cesare , Chiumello Giuseppe 
Published: August 2004

Objective. To investigate the prevalence of celiac disease in a large cohort of children and adolescents at the onset of type 1 diabetes and the occurrence of new cases during a 6-year follow-up.
Methods. We prospectively studied, by repeated serologic screening, 274 consecutive patients at the onset of type 1 diabetes (age [mean ± standard deviation]: 8.28 ± 4.65 years) for 6 subsequent years. One patient had a diagnosis of celiac disease before the onset of diabetes. The immunoglobulin A-antiendomysium antibody test was selected as the screening test; patients with positive results (++ or +++) or with 2 consecutive weak positive tests (+) were considered appropriate for the jejunal biopsy.
Results. At diabetes onset, 15 (5.5%) of 273 patients tested positive with the antiendomysium test; jejunal biopsy was performed in 10, and celiac disease was diagnosed in 9. The prevalence of biopsy-confirmed celiac disease at the manifestation of diabetes was 3.6% (10 of 274 patients). Twelve more patients with a negative antiendomysium antibody test at diabetes onset tested positive during the follow-up within 4 years; 10 of them had biopsies performed, and 7 had celiac disease. Therefore, the overall prevalence of biopsy-confirmed celiac disease in the entire cohort of patients was 6.2%. The age at diabetes onset in patients with and without celiac disease was not different (7.88 ± 5.69 vs 8.3 ± 4.58 years). The majority of cases of celiac disease were asymptomatic in their presentation, and no signs of overt malnutrition were documented.
Conclusions. The prevalence of celiac disease in patients with type 1 diabetes is approximately 20 times higher than in the general population. Sixty percent of cases are already present at diabetes onset, mostly undetected, but an additional 40% of patients develop celiac disease a few years after diabetes onset. Extending screening programs for celiac disease after the onset of type 1 diabetes is recommended, even in the absence of clinical symptoms.
Hepatitis A Virus Infections in the United States: Model-Based Estimates and Implications for Childhood Immunization
Authors: Armstrong Gregory L. , Bell Beth P. 
Published: August 2004

Objective. The high prevalence of antibody to hepatitis A virus (HAV) in the US population suggests that the incidence of infection is much higher than reported, but the infection rate is difficult to measure directly because of anicteric infection and underreporting. We present a model that reconciles the reported incidence of hepatitis A with the observed prevalence of antibody to HAV and provides an estimate of the true incidence of HAV infection.Methods. In the model, reported incidence of hepatitis A in the United States was adjusted to account first for anicteric infection and then for underreporting and declining incidence over time such that the prevalence predicted by the model approximated that observed in 2 nationwide surveys.Results. The model showed incidence in the susceptible population declining by 4.5% per year. As incidence declined early in the 1900s, the average age at infection increased, leading to a paradoxical increase in the incidence of icteric infection followed by a slow decline. The model estimated approximately 270 000 (range: 190 000–360 000) infections annually from 1980 to 1999, 10.4 times the number of hepatitis A cases actually reported during this period. More than half of these infections occurred in children who were younger than 10 years, most of which would have been clinically unrecognizable as hepatitis.Conclusions. These results suggest a large reservoir of infection in children and that interruption of transmission in children may substantially reduce incidence of hepatitis A overall.