bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Contribution of Prone Sleeping Position to the Racial Disparity in Sudden Infant Death Syndrome: The Chicago Infant Mortality Study
Authors: Hauck Fern R. , Moore Cathryn Merrick , Herman Stanislaw M. , Donovan Mark , Kalelkar Mitra , Christoffel Katherine Kaufer , Hoffman Howard J. , Rowley Diane 
Published: August 2004

Background. Rates of sudden infant death syndrome (SIDS) are over twice as high among African Americans compared with Caucasians. Little is known, however, about the relationship between prone sleeping, other sleep environment factors, and the risk of SIDS in the United States and how differences in risk factors may account for disparities in mortality.Objective. To assess the contribution of prone sleeping position and other potential risk factors to SIDS risk in a primarily high-risk, urban African American population.Design, Setting, and Population. Case-control study consisting of 260 infants ages birth to 1 year who died of SIDS between November 1993 and April 1996. The control group consists of an equal number of infants matched on race, age, and birth weight. Prospectively collected data from the death scene investigation and a follow-up home interview for case infants were compared with equivalent questions for living control participants to identify risk factors for SIDS.Main Outcome Measures. Risk of SIDS related to prone sleeping position adjusting for potential confounding variables and other risk factors for SIDS, and comparisons by race-ethnicity.Results. Three quarters of the SIDS infants were African American. There was more than a twofold increased risk of SIDS associated with being placed prone for last sleep compared with the nonprone positions (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.6–3.7). This OR increased after adjusting for potential confounding variables and other sleep environment factors (OR: 4.0; 95% CI: 1.8–8.8). Differences were found for African Americans compared with others (OR: 1.8; 95% CI: 1.2–2.6 and OR: 10.3, 95% CI: 10.3 [3.2–33.8, respectively]). The population attributable risk was 31%. Fewer case mothers (46%) than control mothers (64%) reported being advised about sleep position in the hospital after delivery. Of those advised, a similar proportion of case mothers as control mothers were incorrectly told or recalled being told to use the prone position, but prone was recommended in a higher proportion of black mothers (cases and controls combined) compared with nonblack mothers.Conclusions. Prone sleeping was found to be a significant risk factor for SIDS in this primarily African American urban sample, and approximately one third of the SIDS deaths could be attributed to this factor. Greater and more effective educational outreach must be extended to African American families and the health personnel serving them to reduce prone prevalence during sleep, which appears, in part, to contribute to the higher rates of SIDS among African American infants.
Do Children With Falling Blood Lead Levels Have Improved Cognition?
Authors: Liu Xianchen , Dietrich Kim N. , Radcliffe Jerilynn , Ragan N. Beth , Rhoads George G. , Rogan Walter J. 
Published: August 2004

Objective. Exposure to lead at levels encountered by urban children impairs cognitive development. An observational study suggested improvement in IQ when blood lead level fell, but the only randomized trial of chelation showed no benefit in IQ.
Methods. We did a new analysis of the data from the clinical trial using change in blood lead level as the independent variable. The 741 children began with blood lead levels between 20 and 44 μg/dL, and were 13 to 33 months old at randomization to chelation or placebo. Blood lead levels were measured repeatedly, and cognitive tests were given at baseline, 6 months, and 36 months follow-up.
Results. By 6 months after randomization, blood lead levels had fallen by similar amounts in both chelated and placebo children, despite the immediate drops in the chelated group; there was no association between change in blood lead level and change in cognitive test score. Blood lead levels continued to fall. At 36 months follow-up, in the placebo group only, cognitive test scores had increased 4.0 points per 10 μg/dL fall in blood lead level from baseline to 36 months follow-up and 5.1 points from 6 to 36 months.
Conclusions. The improvement in scores in the placebo group only implies that factors other than declining blood lead levels per se are responsible for cognitive improvement; it is possible but less likely that succimer, the active drug, impairs cognition.
Adjusting Our View of Injury Risk: The Burden of Nonfatal Injuries in Infancy
Authors: Powell Elizabeth C. , Tanz Robert R. 
Published: August 2004

Objective. To describe the incidence, external cause, and types of injuries among infants treated in US emergency departments (EDs) and to compare the external cause of nonfatal to fatal injuries.Design. ED survey from the National Center for Health Statistics (NCHS) National Hospital Ambulatory Medical Care Survey for 1992–1999 and NCHS mortality data.Patients. National probability sample of patients treated in EDs; data for children &lt;1 year old were used.Outcome Measures. Incidence and external cause of nonfatal injury among infants. Rates were calculated using NCHS data for live births.Results. The 8-year annualized, weighted estimate of infant injuries was 426 957, a rate of 108.2 per 1000 infant years (95% confidence interval [CI]: 94.8–121.5). There were no significant differences in rates by sex, race, or ethnicity. An estimated 6% were admitted to the hospital (admission rate: 6.1 per 1000). Most injuries occurred in the home. Head trauma accounted for injuries in 12% of children (injury rate: 13.4 per 1000 per year [95% CI: 9.3–17.3]; 21% of children with head trauma had a skull fracture or an intracranial injury. An estimated 30.2 per 1000 (95% CI: 23.8–36.6) had face trauma and 23.9 per 1000 (95% CI: 18.2–29.6) had extremity injuries; open wounds or superficial injuries accounted for many of these injuries. An estimated 4% had extremity fractures (annual rate: 4.6/1000). Falls were the most frequent cause of injury (an estimated 35.1 per 1000 infant years). The rate of motor vehicle traffic injuries was 8.8 per 1000. Foreign bodies accounted for an estimated 5.2 injuries and poisonings for an estimated 3.8 injuries per 1000 infant years. A comparison with infant mortality data showed the ratio of nonfatal to fatal falls to be 8789:1. The ratio of nonfatal to fatal motor vehicle traffic injuries was 197:1. There were an estimated 1271 nonfatal poisonings for each poisoning fatality.Conclusions. Nonfatal injuries far outnumber fatalities. Injuries from falls are very common, but they are rarely fatal. Surveillance of nonfatal injuries is essential to accurately describe and understand the burden of injury among infants. Prevention strategies must be developed to address extremely frequent, less serious injuries in infancy.
Smallpox Vaccine
Authors:   Committee on Infectious Diseases
Published: August 2004

This Policy Statement was retired January 2006.
After an extensive worldwide eradication program, the last nonlaboratory case of smallpox occurred in 1977 in Somalia. In 1972, routine smallpox immunization was discontinued in the United States, and since 1983, vaccine production has been halted. Stockpiled vaccine has been used only for laboratory researchers working on orthopoxviruses. In recent years, there has been concern that smallpox virus stocks may be in the hands of bioterrorists, and this concern has been heightened by the terrorist attack on the World Trade Center and the Pentagon on September 11, 2001. Because most of the population is considered to be nonimmune, there is debate as to whether smallpox immunization should be resumed. This statement reviews the current status of smallpox vaccine, the adverse effects that were associated with smallpox vaccine in the past, and the major proposals for vaccine use. The statement provides the rationale for a policy based on the so-called ring vaccination strategy recommended by the Centers for Disease Control and Prevention, in which cases of smallpox are rapidly identified, infected individuals are isolated, and contacts of the infected individuals as well as their contacts are immunized immediately.
Summary Statistics for Pediatric Psychiatric Visits to US Emergency Departments, 1993–1999
Authors: Sills Marion R. , Bland Shayne D. 
Published: August 2004

Objectives. To describe characteristics of emergency department (ED) encounters for pediatric patients with an acute mental health diagnosis.
Methods. Data are from the National Hospital Ambulatory Medical Care Survey, which includes abstracts from the medical records of a national probability sample of visits to EDs. Analysis was limited to records of patients who were younger than 19 years and had a diagnosis of either confirmed or suspected mental disorder or a suicide attempt.
Results. There was an estimated annual average of 434 000 ED pediatric mental health visits from 1993 to 1999, an average annual rate of 326.8 visits per 10 000 people. Visit rates varied by patient’s region, age, race, and gender. Psychosis was the diagnosis in 10.8% of these patients, and suicide attempt was the diagnosis in 13.6%. ED pediatric mental health visits accounted for 1.6% of all ED visits in this age group.
Conclusions. The significant increase in emergency department pediatric mental health (EDPMH) visits from 1993–1999 is greatest among patients who are non-white, teenaged, female, and live in the Northeast or Midwest. This variation in EDPMH visits may reflect variability in the shortage of mental health providers. The lack of increase in the 2 categories of diagnoses mandatorily seen in EDs—psychoses and suicide attempts—suggests that the overall rise in EDPMH visits may have been attributable to nonurgent complaints more appropriately managed by a primary mental health provider.
Patterns of Colonization WithUreaplasma urealyticumDuring Neonatal Intensive Care Unit Hospitalizations of Very Low Birth Weight Infants and the Development of Chronic Lung Disease
Authors: Castro-Alcaraz Susana , Greenberg Ellen M. , Bateman David A. , Regan Joan A. 
Published: August 2004

Background. Ureaplasma urealyticum and its association with chronic lung disease (CLD) of prematurity has remained a controversial topic. To readdress this question, we performed a longitudinal study using culture and polymerase chain reaction to detect U urealyticum in the respiratory tract of very low birthweight infants throughout their neonatal intensive care unit hospitalizations.Methods. We screened 125 infants weighing &lt;1500 g and/or &lt;32 weeks’ gestational age over a 12-month period, collecting endotracheal, nasopharyngeal, and throat specimens on days of age 1, 3, 7, and weekly thereafter. CLD was defined as dependency on supplemental oxygen at 28 days and at 36 weeks’ postconceptional age.Results. Forty infants (32%) had 1 or more positive specimens by culture or polymerase chain reaction. We identified 3 patterns of U urealyticum colonization: persistently positive (n = 18), early transient (n = 14), and late acquisition (n = 8). We compared the rates of CLD in each of the 3 colonized groups with the rate of CLD in the noncolonized group. We found a significantly higher rate of CLD at 28 days of age (odds ratio: 8.7; 95% confidence interval: 3.3, 23) and at 36 weeks’ postconception (odds ratio: 38.5, 95% confidence interval: 4.0, 374) only for infants with persistently positive colonization.Conclusions. This study demonstrates that the risk of developing CLD varies with the pattern of U urealyticum colonization. Only the persistently positive colonization pattern, which accounted for 45% of the U urealyticum-positive infants, was associated with a significantly increased risk of development of CLD.
Paroxysmal Nonepileptic Events in Children and Adolescents
Authors: Kotagal Prakash , Costa Maristela , Wyllie Elaine , Wolgamuth Barbara 
Published: August 2004

Objective. Paroxysmal nonepileptic events (PNEs) are frequently encountered in children and adolescents; however, there is little information concerning the relative frequency of various types of these disorders. We report our experience with PNEs in a group of children and adolescents who underwent prolonged video-electroencephalographic monitoring.Methods. During a 6-year period, 883 patients were monitored in the Pediatric Epilepsy Monitoring Unit and 134 patients (15.2%) were documented to have PNEs on the basis of a typical spell recorded during monitoring. Their hospital charts were reviewed and videotapes of these events were analyzed.Results. Patients were divided into 3 age groups: 1) the Infant, Toddler, and Preschool Group (2 months–5 years) that comprised 26 patients. The most common diagnoses were stereotyped movements, hypnic jerks, parasomnias, and Sandifer syndrome. Concomitant epilepsy was present in 12 patients (46%). 2) The School-Age Group (5–12 years) consisted of 61 patients. The most frequent diagnoses were conversion disorder (psychogenic seizures), inattention or daydreaming, stereotyped movements, hypnic jerks, and paroxysmal movement disorders. Fifteen patients (25%) had concomitant epilepsy. 3) The Adolescent Group (12–18 years) consisted of 48 patients, of whom 40 patients (83%) were diagnosed with conversion disorder. Nine patients (19%) had concomitant epilepsy.Conclusions. In our patients with PNEs, conversion disorder was seen in children &gt;5 years old and its frequency increased with age, becoming the most common type of PNEs among adolescents. In adolescents, conversion disorder was more common in females, whereas males predominated in the school-aged group. Concomitant epilepsy with nonepileptic events occurred in all 3 age groups to a varying extent.
Stunting May Determine the Severity of Malaria-Associated Anemia in African Children
Authors: Verhoef Hans , West Clive E. , Veenemans Jacobien , Beguin Yves , Kok Frans J. 
Published: August 2004

Objective. Evidence from previous studies that malnourished children are protected against malaria is controversial. In individuals repeatedly exposed to malaria, immunity may develop first against severe disease, then against pyrogens, and last, against parasites. If this is true, this would suggest that reduced immune function that may exist in stunted children exacerbates the severity of malarial signs and symptoms, rather than the occurrence of parasitemia. On the other hand, several studies have suggested that malnourished children are protected to some degree against malaria. Our aim was to evaluate whether observational data support the hypothesis that nutritional inadequacies that cause stunting modify the associations between malaria and hematologic indicators such as hemoglobin concentration and serum concentrations of C-reactive protein and soluble transferrin receptor (sTfR). We showed earlier that increased serum concentrations of these receptors in asymptomatic malaria may be explained, at least in part, by increased erythropoiesis to compensate for malaria-induced hemolysis.
Methodology. Community-based cluster survey among Kenyan children aged 2 to 36 months asymptomatic for malaria or anemia (n = 318).
Results. When adjusted for age and wasting, the malaria-associated decrease in mean hemoglobin concentration was 8.5 g/L and 15.8 g/L in nonstunted and stunted children, respectively. The malaria-associated increase in geometric mean serum concentrations of sTfR was 1.1-fold and 1.8-fold in nonstunted and stunted children, respectively. The malaria-associated increase in geometric mean serum concentrations of C-reactive protein was 1.4-fold and 2.3-fold in nonstunted and stunted children, respectively. Thus, children with malaria and those who were stunted suffered from more severe anemia and had higher serum concentrations of C-reactive protein and sTfR than would be expected from the combined effect of the 2 working independently.
Conclusions. Our results are consistent with the notion that the nutritional inadequacies causing stunting also impair host immunity, thus increasing the degree to which malaria is associated with decreased concentrations of hemoglobin, with increased inflammation, and with increased iron demand in developing erythroblasts. Increased intake of micronutrients may not only reduce stunting and nutritional anemia, but also reduce malaria-associated anemia.
Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments
Authors: Johnson David W. , Adair Carol , Brant Rollin , Holmwood Joanne , Mitchell Ian 
Published: August 2004

Objective. It is uncertain whether pediatric and general emergency departments have different admitting practices regarding children with bronchiolitis. The objective of this study was to quantify the differences in admission practices between pediatric and general emergency departments of children with bronchiolitis in 1 North American metropolitan area, controlling for various factors such as clinical severity, comorbid conditions, and socioeconomic status.Design. Retrospective cohort review of emergency department visits from April 1992 to March 1997.Setting. Five emergency departments (1 pediatric and 4 general) serving the Calgary Health Region, which encompasses ∼850 000 people.Patients. All children residing within the region who visited a regional emergency department and were diagnosed to have bronchiolitis (International Classification of Diseases, Ninth Revision code 466.1, primary or secondary diagnosis).Main Outcome Measure. Population-standardized estimates of admission rates.Results. The medical charts of 3091 children diagnosed to have bronchiolitis during the study period were reviewed. Of this number, 2496 children were evaluated at the pediatric emergency department, and 629 (25%) were admitted. The remaining 595 (19%) were evaluated at the general emergency departments, and 221 (37%) were admitted. Controlling for age, gender, estimated family income based on postal code, medical comorbidity, and clinical severity estimated by presenting respiratory rate and room air oxygen saturation, population-standardized estimates for admission rates at the pediatric and general emergency departments were 24% (standard error: 1%) and 43% (standard error: 2%), respectively.Conclusion. Children diagnosed to have bronchiolitis at the Calgary Health Region’s pediatric emergency department were about half as likely to be admitted to the hospital as children diagnosed at the region’s general emergency departments.
Moderate Hyperbilirubinemia Induces a Transient Alteration of Neonatal Behavior
Authors: Paludetto Roberto , Mansi Giuseppina , Raimondi Francesco , Romano Antonia , Crivaro Valeria , Bussi Marianna , D’Ambrosio Giovanna 
Published: August 2004

Objective. To investigate the behavioral changes induced by moderate hyperbilirubinemia in the otherwise healthy, untreated newborn infant.Methods. Fifty term neonates (23 boys) with untreated moderate hyperbilirubinemia (median: 14.3 mg/dL; range: 13.2–20 mg/dL) and 50 matched control subjects with lower bilirubin concentrations (median: 9.1 mg/dL; range: 5.3–12 mg/dL) were administered the Brazelton Neonatal Behavioral Scale at 87 hours of life (range: 72–110 hours). A subgroup analysis was also performed at 104 hours of life (range: 96–134 hours) and at 3 weeks of age.Results. At the first examination, all behavioral clusters were significantly altered in the group with moderate hyperbilirubinemia. The visual and auditory capabilities of the hyperbilirubinemic infant were especially compromised. Although social-interactive cluster scores significantly correlated both with serum bilirubinemia and birth weight, the former accounted for 8.7% of the variance and the latter accounted for only 4.7%. The moderate hyperbilirubinemia neonates’ scores also showed a negative correlation with the autonomic system and more frequent presence of tremors. After 24 hours, a decrease in serum bilirubin within the moderate hyperbilirubinemic group was associated with improved scores. At 3 weeks of age, the behavioral assessment of the 2 groups did not show significant differences.Conclusions. Untreated moderate hyperbilirubinemia is associated with a transient and apparently reversible alteration of neonatal behavior, particularly in the social-interactive area.
Caller Satisfaction With After-Hours Telephone Advice: Nurse Advice Service Versus On-Call Pediatricians
Authors: Lee Thomas J. , Guzy Judith , Johnson David , Woo Heide , Baraff Larry J. 
Published: August 2004

Objective. To compare caller satisfaction with after-hours medical advice provided by a for-profit nurse advice service with advice provided by on-call pediatricians.Methods. The study setting was the general pediatrics faculty practice of an urban university medical center. Participants were parents or guardians of a population of ∼6000 children calling for after-hours medical advice over a 10-month period from January 18 to November 20, 2000. After-hours medical advice calls were randomized to either a nurse advice service or the on-call pediatrician. Caller satisfaction and subsequent health care utilization were measured by a telephone survey of callers and review of all health care visits within 3 days of the initial telephone advice call.Results. Five hundred sixty-six (48%) callers were enrolled in the on-call pediatrician group, and 616 (52%) were enrolled in the advice nurse group. Caller satisfaction was rated as very good or excellent significantly more often for the on-call pediatrician than for the nurse advice service as follows: telephone call overall (68.5% vs 55.0%; 95% confidence interval [CI] of difference: 8.0%–19.0%), thoroughness and competence of the person they spoke with (74.0% vs 59.1%; 95% CI of difference: 9.6%–20.2%), courtesy and friendliness of the person they spoke with (77.4% vs 73.9%; 95% CI of difference: −1.4%-8.4%), length of time spent waiting (70.8% vs 60.1%; 95% CI of difference: 5.4%–16.2%), time spent talking with the on-call pediatrician or advice nurse (68.2% vs 52.4%; 95% CI of difference: 10.2%–21.3%), and the medical advice given (68.6% vs 53.9%; 95% CI of difference: 9.2%–20.1%). Compliance with the advice given was significantly higher for office care in the on-call pediatrician group (51.5% vs 29.6%; 95% CI of difference: 8.9%–34.2%). Repeat calls for advice were significantly more frequent for the nurse advice service, both within 4 hours (13.0% vs 4.8%; 95% CI of difference: 5.0%–11.4%), and within 72 hours (23.4% vs 13.3%; 95% CI of difference: 5.8%–14.5%).Conclusion. Callers were less satisfied with medical advice provided by a nurse advice service compared with the traditional on-call pediatrician. The lower satisfaction was associated with somewhat poorer compliance with recommended triage dispositions and more frequent repeat calls for medical advice.