bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immunologic and Epidemiologic Experience of Vaccination With a Monocomponent Pertussis Toxoid Vaccine
Authors: Taranger John , Trollfors Birger , Bergfors Elisabet , Knutsson Nina , Lagergård Teresa , Schneerson Rachel , Robbins John B. 
Published: August 2004

Pertussis re-emerged in Sweden with a cumulative incidence of about 60% during the first 10 years of life, when the locally produced cellular vaccine lost its efficacy around 1970 and general vaccination was discontinued in 1979. The epidemiology, clinical features, and immunology of pertussis and a monocomponent pertussis toxoid vaccine were studied in Göteborg, Sweden.After phase 1 and 2 studies, a randomized, double-blind, placebo-controlled trial of pertussis toxoid (PTox), compounded with diphtheria and tetanus toxoids, was administered to 3450 children according to the Swedish schedule at 3, 5, and 12 months of age. After a mean follow-up of 18 months, the efficacy was 71% overall and 75% in household contacts, respectively. A statistically significant correlation was found between the level of PTox-induced antibodies and protection against pertussis. As observed with cellular and with multicomponent acellular vaccines, PTox reduced the severity of disease and the percent of children with positive cultures. Furthermore, vaccination reduced the transmission of Bordetella pertussis to household contacts in the vaccinees compared with the controls who received only diphtheria and tetanus toxoids. Patients with culture-verified Bordetella parapertussis infection reacted with antibodies to pertactin and to filamentous hemagglutinin but not to pertussis toxin, and some subsequently developed pertussis. The antibody responses of patients with pertussis to the surface polysaccharides of B pertussis and to B parapertussis were cross-reactive serologically. Serosurveys showed that only antibodies to pertussis toxin were related to the occurrence of pertussis in the general population: antibodies to filamentous hemagglutinin and pertactin were probably stimulated by antigens of other bacteria as well as Bordetellae.Mass vaccination of Göteborg children born in the 1990s was started in 1995. In February 1999, about 55% had been vaccinated and both B pertussis and pertussis decreased significantly in individuals of all ages (herd immunity). Similar to diphtheria, PTox-induced immunity to pertussis occurs both on an individual and community basis.The apparent greater efficacy of multicomponent acellular pertussis vaccines compared with monocomponent PTox was proposed to be an artifact created when the diagnosis of pertussis was made by the serologic criteria of the World Health Organization only. Our conclusion is that PTox is both an essential and alone sufficient antigen in acellular pertussis vaccines.
Medical Staff Appointment and Delineation of Pediatric Privileges in Hospitals
Authors: O’Connor Mary E. ,   Committee on Hospital Care
Published: August 2004

The review and verification of credentials and the granting of clinical privileges are required of every hospital to ensure that members of the medical staff are competent and qualified to provide specified levels of patient care. The credentialing process involves the following: 1) assessment of the professional and personal background of each practitioner seeking privileges; 2) assignment of privileges appropriate for the clinician’s training and experience; 3) ongoing monitoring of the professional activities of each staff member; and 4) periodic reappointment to the medical staff on the basis of objectively measured performance.
This statement examines the essential elements of a credentials review for initial and renewed medical staff appointments along with suggested criteria for the delineation of clinical privileges. Sample forms for the delineation of privileges can be found on the American Academy of Pediatrics Web site (http://www.aap.org/visit/cmte19.htm). Because of the differences in individual hospitals, no one method for credentialing is universally applicable. The medical staff of each hospital must, therefore, establish its own process based on the general principles reviewed in this statement. The issues of medical staff membership and credentialing have become very complex, and institutions and medical staffs are vulnerable to legal action. Consequently, it is advisable for hospitals and medical staffs to obtain expert legal advice when medical staff bylaws are constructed or revised.
Health Supervision for Children With Turner Syndrome
Authors: Frías Jaime L. , Davenport Marsha L. ,   Committee on Genetics,   Section on Endocrinology
Published: August 2004

This Clinical Report was retired October 2008.
This report is designed to assist the pediatrician in caring for the child in whom the diagnosis of Turner syndrome has been confirmed by karyotyping. The report is meant to serve as a supplement to the American Academy of Pediatrics’ “Recommendations for Preventive Pediatric Care” and emphasizes the importance of continuity of care and the need to avoid its fragmentation by ensuring a medical home for every girl with Turner syndrome. The pediatrician’s first contact with a child with Turner syndrome may occur during infancy or childhood. This report also discusses interactions with expectant parents who have been given the prenatal diagnosis of Turner syndrome and have been referred for advice.
Maternal Depression, Changing Public Assistance, Food Security, and Child Health Status
Authors: Casey Patrick , Goolsby Susan , Berkowitz Carol , Frank Deborah , Cook John , Cutts Diana , Black Maureen M. , Zaldivar Nieves , Levenson Suzette , Heeren Tim , Meyers Alan ,   the Children’s Sentinel Nutritional Assessment Program Study Group
Published: August 2004

Objective. To examine the association of positive report on a maternal depression screen (PDS) with loss or reduction of welfare support and foods stamps, household food insecurity, and child health measures among children aged ≤36 months at 6 urban hospitals and clinics.Methods. A convenience sample of 5306 mothers, whose children &lt;36 months old were being seen in hospital general clinics or emergency departments (EDs) at medical centers in 5 states and Washington, District of Columbia, were interviewed from January 1, 2000 until December 31, 2001. Questions included items on sociodemographic characteristics, federal program participation and changes in federal benefits, child health status rating, child’s history of hospitalizations since birth, household food security status, and a 3-question PDS. For a subsample interviewed in the ED, whether the child was admitted to the hospital that day was recorded.Results. PDS status was associated with loss or reduction of welfare support and food stamps, household food insecurity, fair/poor child health rating, and history of child hospitalization since birth but not low child growth status measures or admission to the hospital at the time of ED visit. After controlling for study site, maternal race, education, and insurance type as well as child low birth weight status, mothers with PDS were more likely to report fair/poor child health (adjusted odds ratio [AOR]: 1.58; 95% confidence interval [CI]: 1.33–1.88) and hospitalizations during the child’s lifetime (AOR: 1.20; 95% CI: 1.03–1.39), compared with mothers without PDS. Controlling for the same variables, mothers with PDS were more likely to report decreased welfare support (AOR: 1.52; 95% CI: 1.03–2.25), to have lost food stamps (AOR: 1.56; 95% CI: 1.06–2.30), and reported more household food insecurity (AOR: 2.69; 95% CI: 2.33–3.11) than mothers without PDS.Conclusion. Positive maternal depression screen status noted in pediatric clinical samples of infants and toddlers is associated with poorer reported child health status, household food insecurity, and loss of federal financial support and food stamps. Although the direction of effects cannot be determined in this cross-sectional survey, child health providers and policy makers should be aware of the potential impact of maternal depression on child health in the context of welfare reform.
Evaluation of Neonatal Intensive Care for Extremely Low Birth Weight Infants in Victoria Over Two Decades: I. Effectiveness
Authors: Doyle Lex W. ,   the Victorian Infant Collaborative Study Group
Published: August 2004

Context. Although individual components of neonatal intensive care have proven efficacy, doubts remain about its overall effectiveness.Objective. To determine the changes in effectiveness of neonatal intensive care for extremely low birth weight (ELBW) infants over 2 decades.Design. Population-based cohort study of consecutive ELBW infants born during 4 distinct eras: 1979–1980, 1985–1987, 1991–1992, and 1997, all followed to at least 2 years of age.Setting. The state of Victoria, Australia.Patients. All ELBW live births of birth weight 500 to 999 g in the state in the calendar years indicated (1979–1980 [n = 351]; 1985–1987 [n = 560]; 1991–1992 [n = 429]; 1997 [n = 233]). Survivors were assessed at 2 years of age by pediatricians and psychologists blinded to perinatal details. The follow-up rates were high for each ELBW cohort (1979–1980: 100% [89 of 89]; 1985–1987: 100% [212 of 212]; 1991–1992: 98% [237 of 241]; 1997: 99% [168 of 170]).Main Outcome Measures. Survival and quality-adjusted survival rates at 2 years of age.Results. The survival rate to 2 years of age improved significantly between successive eras (absolute increase and 95% confidence interval: 1985–1987 vs 1979–1980, 12.5% and 6.3%–18.4%; 1991–1992 vs 1985–1987, 18.3% and 12.1%–24.4%; 1997 vs 1991–1992, 16.8% and 9.2%–23.9%), as did the quality-adjusted survival rate (absolute increase: 1985–1987 vs 1979–1980, 12.4%; 1991–1992 vs 1985–1987, 13.8%; 1997 vs 1991–1992, 13.2%). Overall, the survival rate increased from ∼1 in 4 (25%) in 1979–1980 to 3 in 4 (73%) in 1997, and the quality-adjusted survival rate also increased threefold, from 19% in 1979–1980 to 59% in 1997. The biggest gains in survival and quality-adjusted survival in the most recent era were in infants in lighter birth-weight subgroups.Conclusion. The effectiveness of neonatal intensive care for ELBW infants in Victoria improved progressively from the late 1970s to the late 1990s.
Varicella and Zoster in Children After Kidney Transplantation: Long-term Results of Vaccination
Authors: Broyer Michel , Tete Marie José , Guest Genevieve , Gagnadoux Marie France , Rouzioux Christine 
Published: August 2004

Objective. To determine the long-term prevalence of varicella infection and herpes zoster after kidney transplantation and to assess the effectiveness of varicella immunization with the Oka attenuated strain.
Methods. This study involved 704 children and adolescents who received a kidney graft in our institution from 1973 to 1994 and had routinely been given varicella vaccine beginning in 1980 in preparation for transplantation.
Results. After vaccination 62% of these patients still had varicella/zoster (VZ) antibodies at 1 year and 42% after 10 years. After transplantation the incidence of varicella was significantly lower, 26/212 (12%), in patients who received immunization than in those who did not and had no history of varicella, 22/49 (45%). The disease was also significantly less severe in the vaccinated patients (three deaths among naive patients vs none among vaccinees). In the vaccinees, varicella infection was observed only in those who did not develop or lost VZ antibodies; in addition, 21 patients of this subgroup had an asymptomatic seroconversion. Four of the 415 patients with a history of varicella had another episode of benign varicella after grafting. Herpes zoster was observed in 76 of the 704 patients included in the study. The prevalence differed according to VZ status at the time of grafting: 13% in patients with a history of varicella, 7% in the vaccinees, and 38% in the naive patients at grafting who developed varicella. Three rejection episodes occurred in association with a varicella episode and four with a zoster episode, but graft function was only transiently impaired, and as a whole varicella or zoster did not significantly affect graft function or survival.
Conclusion. Naive VZ patients with a kidney graft are at risk to develop severe varicella and this may be effectively prevented by available immunization.
β2-Agonist Metered Dose Inhaler Overuse: Psychological and Demographic Profiles
Authors: Beausoleil Janet L. , Weldon Daniel P. , McGeady Stephen J. 
Published: August 2004

Objective. To identify psychological and demographic correlates of children and adolescents known to overuse β2-agonist metered dose inhalers (β-MDIs).
Design. During residential care for severe asthma, demographic and psychological characteristics of 17 children and adolescents known to be β-MDI overusers were compared with 38 asthmatic subjects of similar age without such history.
Results. β-MDI overuse occurred among all groups; however, males, minorities, and those from lower socioeconomic groups were overrepresented. Overusers scored significantly lower on standardized IQ tests. Subtests of arithmetic for numeric reasoning, comprehension for understanding of social values, and picture completion for visual attention to detail were also significantly lower in β-MDI overusers, as were reading achievement tests. Testing also revealed tendencies toward dominant, shrewd, and undisciplined personality traits in the overusers.
Conclusion. Recognition of these characteristics of children prone to β-MDI overuse will raise the clinician's awareness of this potential. Greater efforts and alternative approaches toward education and treatment of the at-risk patient and family are indicated.
Behavioral Characteristics of Children With Stool Toileting Refusal
Authors: Blum Nathan J. , Taubman Bruce , Osborne Mary L. 
Published: August 2004

Objective. To determine if children with stool toileting refusal have more behavior problems than matched children who are toilet trained.
Design. Case-control study.
Setting. Suburban private pediatric practice.
Participants. Children 30 to 48 months old who had achieved bladder control but refused to defecate on the toilet were identified as cases. Controls were sex- and age-matched children who were fully toilet trained.
Measures. Total behavior problems were assessed using a semi-structured behavior screening interview with the child's parents. The parents also completed the Child Behavior Checklist for ages 2 to 4 and either the Toddler Temperament Scale (30 to 36 months old) or the Behavioral Style Questionnaire (36 to 48 months old). Child compliance with adult instructions was measured during a room clean-up task.
Results. Children with stool toileting refusal were not found to have more behavior problems than the matched children who were toilet trained. There were no differences between the two groups in compliance during the room clean-up task. There was a trend toward children with stool toileting refusal having a more difficult temperament, and these children were reported to have more problems with constipation and painful bowel movements than the controls.
Conclusions. Children with stool toileting refusal do not have more behavior problems than controls who are toilet trained. Parents do report higher rates of constipation and painful defecation, but it is not clear whether this is a cause or effect of stool toileting refusal.
Toilet Training and Toileting Refusal for Stool Only: A Prospective Study
Authors: Taubman Bruce 
Published: August 2004

Objective. To determine the incidence of toileting refusal for bowel movements and its outcome when toilet training children using a child-oriented approach.
Design. Prospective study.
Setting. Private suburban pediatric setting consisting of middle and upper middle class families.
Methods. Healthy children between 18 and 30 months with no signs of developmental delay were enrolled in the study. Parents were given questions regarding their child's toilet training and behavior. Families were followed every 6 months during an office visit or by phone call until the child was successfully day time toilet trained.
Results. A total of 482 children (255 males) completed the study. There were 106 children (54 males) (22%) who experienced at least 1 month of stool toileting refusal. There was an association between the presence of younger siblings (P = .023) and parental inability to set limits for the child (P= .017) and stool toileting refusal. Stool toileting refusers trained at a later age than the rest of the group (P &lt; .0001). Fifty percent (22/44) of the children who trained between 42 and 48 months and 73% (8/11) of the children who trained after 48 months experienced stool toileting refusal. Sixty-one of the study children developed stool withholding during toilet training. Forty-nine (80%) of these children were stool toileting refusers (P &lt; .00001). In 77 (73%) of the children no intervention was undertaken. Of these, the behavior lasted more than 6 months in 20. Intervention was undertaken with 29 children, either because of severe stool withholding (23) or the age of the child (6). Interupting toilet training and having the child return to diapers resulted in the child spontaneously using the toilet for bowel movements within 3 months in 24 of 27 children.
Conclusion. Stool toileting refusal occurred in one in five children in this study population. Two behaviors associated with stool toileting refusal may require the intervention of the pediatrician. The first is stool withholding causing constipation which can result in rectal impaction and primary encopresis. The second is lack of successful toilet training by 42 months of age. A child who is still untrained at this late age can be a source of family conflict and stress requiring the advice and support of the pediatrician.
Pediatric Mortality Probability Estimated From Pre-ICU Severity of Illness
Authors: Kanter Robert K. , Edge Walter E. , Caldwell Cecelia R. , Nocera Mary Alice , Orr Richard A. 
Published: August 2004

Objective. The Pediatric Risk of Mortality (PRISM) score is a measure of illness severity based on abnormalities observed in the bedside examination and laboratory assessment. PRISM scores obtained after pediatric intensive care unit (PICU) admission predict mortality probability, but no previous efforts to evaluate mortality risk before PICU admission have been reported. Our study was performed on patients admitted to PICUs at four pediatric tertiary care centers to derive a quantitative estimate of hospital mortality probability as a function of PRISM scores obtained at referring hospitals before PICU transfer. Performance of the model was tested by evaluating accuracy of mortality predictions obtained from pre-ICU PRISM scores in a separate validation set of patients.
Methods. Patients were randomized to the derivation or validation sets. Data were recorded prospectively from observations made at hospitals referring to the study PICUs. Patients included 780 infants and children with medical and surgical emergencies and trauma. Electively admitted patients were excluded from analysis.
Results. The relationship between mortality probability (P) and the pre-ICU PRISM score is expressed by the equation: P =er/(1 + er). In this equation, r is an empirical function of the pre-ICU PRISM score: r = .197 × PRISM − 4.705. The mortality probability rises from near 0 at low scores, approaching 1 (certainty) above a PRISM score of 40. Mortality probability exceeds 10% at a score of 13 and exceeds 50% at a score of 24. Performance of predictions in the validation set of patients was evaluated for five categories of mortality probability. The observed number of deaths corresponded to predicted mortality across the range of illness severity. When compared for each tertiary institution, observed mortality rates were similar to predictions for three of four institutions. For data obtained at institution D, the observed mortality of 17% significantly exceeded the 7% predicted rate. In infants younger than 1 year, as well as children 1 year and older, observed mortality rates were similar to predicted.
Conclusions. The pre-ICU PRISM score as a measure of illness severity provides an estimate of hospital mortality probability. Further investigation is required to determine the use of pre-ICU mortality estimates in making clinical decisions.
Improving the Vitamin K Status of Breastfeeding Infants With Maternal Vitamin K Supplements
Authors: Greer Frank R. , Marshall Sharon P. , Foley Andrea L. , Suttie John W. 
Published: August 2004

Objective. To increase the phylloquinone (vitamin K1) concentration of human milk with maternal oral phylloquinone supplements such that both the phylloquinone intake of breastfed infants and their serum concentrations of phylloquinone would approach those of formula-fed infants who are known to be at much less risk for hemorrhagic disease of the newborn.
Design. Two stages: stage I, longitudinal, randomized study of 6 weeks' duration; and stage II, longitudinal, randomized, double-blind, placebo-controlled study of 12 weeks' duration.
Setting. Patients from a private pediatric practice in Madison, WI.
Patients. Stage I: sequential sampling of 20 lactating mothers to determine the level of maternal supplementation needed in stage II. Ten mothers received 2.5 mg/d oral phylloquinone, and 10 mothers received 5.0 mg/d oral phylloquinone. Stage II: sequential sampling of 22 human milk-fed infants and lactating mothers. All infants received 1 mg of phylloquinone at birth. Eleven mothers received a placebo; 11 mothers received 5 mg/d phylloquinone.
Measurements and Results. In stage I, both 2.5 and 5.0 mg/d phylloquinone significantly increased the phylloquinone content of human milk at both 2 and 6 weeks. As expected, 5.0 mg had a greater effect (mean ± SD, 58.96 ± 25.39 vs 27.12 ± 12.18 ng/mL at 2 weeks). In stage II, the vitamin K-supplemented group had significantly higher maternal serum phylloquinone concentrations, higher phylloquinone milk concentrations, and higher infant plasma phylloquinone concentrations at 2, 6, and 12 weeks compared with the placebo group. At 12 weeks infant phylloquinone intakes were significantly higher for the vitamin K group than the placebo group (9.37 ± 4.55 vs 0.15 ± 0.07 μg/kg per day). This corresponded to a plasma phylloquinone concentration in the vitamin K group of 2.84 ± 3.09 vs 0.34 ± 0.57 ng/mL in the placebo group. At 12 weeks, the prothrombin times did not differ between the groups, but the des-γ-carboxy-prothrombin (partially carboxylated prothrombin thought to be a measure of vitamin K deficiency) was significantly elevated in the placebo group compared with the vitamin K group (1.48 ± 1.19 vs 0.42 ± 0.55 ng/mL).
Conclusion. In exclusively breastfed infants who receive intramuscular phylloquinone at birth, the vitamin K status as measured by plasma phylloquinone and des-γ-carboxy-prothrombin concentrations is improved by maternal oral supplements of 5 mg/d phylloquinone through the first 12 weeks of life.