bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep Problems Seldom Addressed at Two General Pediatric Clinics
Authors: Chervin Ronald D. , Archbold Kristen Hedger , Panahi Parviz , Pituch Kenneth J. 
Published: August 2004

Objective.Sleep disorders can cause substantial morbidity but often remain undiagnosed among adults. We identified a series of children with sleep-related symptoms and reviewed medical chart notes for the previous 2 years to determine how often sleep problems had been addressed.Design.Observational.Setting.Two university-affiliated but community-based general pediatrics clinics.Patients.Children, ages 2.0 to 13.9 years, with clinic appointments.Measures.Parental and child responses to a validated Pediatric Sleep Questionnaire (PSQ) were used to identify patients at risk for chronic sleep-disordered breathing, periodic leg movements during sleep, insomnia, or excessive daytime sleepiness. Chart notes written within the previous 2 years were searched for sleep-related symptoms, diagnoses, or treatments.Results.A total of 830 questionnaires were completed; 1395 chart notes of 86 symptomatic participants (mean age: 6.6 ± 3.1 years; 51% male) with 103 identified sleep problems were reviewed. Fewer than 15% of patients had current chart notes that mentioned any of the PSQ-defined sleep problems; diagnoses were mentioned for 2 of 86 patients and no treatments were discussed. Among the 103 sleep problems, only 16 received mention in any past or current note; 10 had led to a diagnosis; 4 had led to intervention; and 3 were treated in a manner likely to be effective. Seventy-four of the sleep problems (72%) occurred in children whose charts did mention something about sleep, but such notations rarely related to concerns uncovered by the PSQ.Conclusions.Children with PSQ-identified sleep problems at 2 general pediatrics clinics seldom had these problems addressed, diagnosed, or treated, despite discussions about some aspect of their sleep in the large majority of cases. These findings support expansion of clinician and parent education about sleep disorders in children.
Snoring During Early Childhood and Academic Performance at Ages Thirteen to Fourteen Years
Authors: Gozal David , Pope Dennis W. 
Published: August 2004

Objectives.
Obstructive sleep apnea syndrome in young children is associated with an adverse effect on learning. However, the long-term impact of sleep-disordered breathing (SDB) during early childhood on learning remains unknown.

Methods.
Questionnaires were mailed to seventh and eighth graders attending public schools whose class ranking was either in the top 25% (high performance [HP]) or bottom 25% of their class (low performance [LP]), and who were matched for age, gender, race, school, and street of residence. Snoring frequency and loudness at 2 to 6 years of age, tonsillectomy and adenoidectomy (T&A) for snoring or recurrent infection, school grades, and parental smoking and snoring were assessed.

Results.
The questionnaire response rate was 82.8%. Because of ongoing snoring, 13 responders were excluded, such that 1588 questionnaires could be analyzed (797 in LP and 791 in HP group). Frequent and loud snoring during early childhood was reported in 103 LP children (12.9%) compared with 40 HP children (5.1%; odds ratio: 2.79; confidence interval: 1.88–4.15). Furthermore, 24 LP and 7 HP children underwent T&A for snoring (odds ratio: 3.40; confidence interval: 1.47–7.84), while 21 LP and 19 HP children required surgery for recurrent tonsillitis.

Conclusions.
Children with lower academic performance in middle school are more likely to have snored during early childhood and to require T&A for snoring compared with better performing schoolmates. These findings support the concept that SDB-associated neurocognitive morbidity may be only partially reversible or that a “learning debt” may develop with SDB during early childhood and hamper subsequent school performance.
Access to Orthopedic Care for Children With Medicaid Versus Private Insurance in California
Authors: Skaggs David L. , Clemens Samantha M. , Vitale Michael G. , Femino J. D. , Kay Robert M. 
Published: August 2004

Objective.To compare the availability of timely orthopedic care to a child with a fractured arm insured by Medi-Cal (California state Medicaid) and by private insurance.Study Design.Fifty randomly chosen offices of orthopedic surgeons were telephoned with the following scenario: “My 10-year-old son broke his arm last week during a vacation” followed by a request for an appointment that week. Each office was called twice with an identical script except for insurance status: once with Medi-Cal and once with private insurance.Results.All 50 offices offered an appointment to see the child with private insurance within 7 days. Only 1 of the same 50 offices offered an appointment to see the child with Medi-Cal within 7 days. Of the offices that would not see a child with Medi-Cal, 87% were unable to recommend an orthopedic office that accepted Medi-Cal.Conclusions.Timely access to orthopedic care was available in 100% of offices polled to a child with private insurance versus in 2% of offices to a child with Medi-Cal. This is a significant difference. Lack of timely orthopedic care may result in poor outcome, ie, if a fracture is not properly aligned in the first few weeks, a permanent deformity may result. Although causation cannot be established from this study, we suspect that Medi-Cal reimbursement rates below the cost of office overhead may be of significance. Although federal guidelines require that payments must be sufficient to enlist enough providers so that services to Medi-Cal recipients are available to the same extent as those available to the general population, this study finds that that children with Medi-Cal insurance have significantly less access to timely orthopedic care.
“You Are Hereby Commanded to Appear”: Pediatrician Subpoena and Court Appearance in Child Maltreatment
Authors: Palusci Vincent J. , Hicks Ralph A. , Vandervort Frank E. 
Published: August 2004

Objective.To determine the frequency of court appearance by pediatricians evaluating child abuse and neglect cases and to identify case characteristics associated with actual court appearance or case adjournment.Design.Retrospective review of subpoenas received between 1995 and 1999 for child maltreatment cases personally evaluated by 2 pediatricians during the years 1995 to 1998. Information was collected regarding patient age, gender, race/ethnicity, type of suspected maltreatment, date of evaluation, date of subpoena, type of court hearing, whether the pediatrician actually testified in court, and legal outcomes. Case characteristics were compared between pediatricians and were used to predict physician appearance and case continuance or adjournment in logistic regression models.Results.Four hundred forty-five subpoenas concerning 260 patients were received. Although significant differences were noted between the pediatricians in type of abuse, no differences were found in patient age, gender, ethnicity or legal outcomes. The pediatricians received subpoenas in &lt;15% of child maltreatment cases, and &lt;5% of children seen resulted in the physician being required to actually appear in court. No case characteristics significantly predicted court appearance or case continuance or adjournment.Conclusions.Although pediatricians are sometimes subpoenaed to appear in court to explain the medical evaluation and the needs of the child in cases of child abuse and neglect, most court cases were continued, adjourned, or settled before physician testimony. Most subpoenas did not result in the pediatrician going to court, and it is unclear which child factors may predict court involvement. Pediatricians can take steps to minimize (but not eliminate) the potential dissatisfaction and inconvenience associated with receiving and responding to subpoenas in child maltreatment cases.
Exposure to Lead Appears to Selectively Alter Metabolism of Cortical Gray Matter
Authors: Trope Idit , Lopez-Villegas Dolores , Cecil Kim M. , Lenkinski Robert E. 
Published: August 2004

Objective.The effects of lead poisoning on the development of children have been examined primarily in the context of behavioral and neuropsychological studies. The purpose of this study was to examine the in vivo use of magnetic resonance spectroscopy (MRS) for the evaluation of the neurotoxic effects of lead on the nervous system. MRS has the ability to monitor brain metabolism by detecting a number of neurochemicals among which is N-acetylaspartate, a metabolite shown to decrease in processes that involve neuronal loss.Methods.In the present study we evaluated the metabolism of gray and white matter of frontal cortex using MRS in individuals with elevated blood lead levels and compared the results with those obtained on nonlead-exposed controls.Results.Although all of the participants had normal MRI examinations of the brain, the lead-exposed individuals exhibited a significant reduction in the N-acetylaspartate/creatine and phosphocreatine ratios in frontal gray matter compared with the nonlead-exposed controls.Conclusions.The findings of this study suggest that lead has an effect on brain metabolites as detected by MRS in vivo. More specifically, we have found statistically significant reduced levels of brain metabolites in gray but not white matter in lead-exposed individuals. These results imply that MRS is able to detect metabolic abnormalities in individuals with lead poisoning.
Organized Sports for Children and Preadolescents
Authors:   Committee on Sports Medicine and Fitness and Committee on School Health
Published: August 2004

This Clinical Report was revised. See https://doi.org/10.1542/peds.2019-0997.
Participation in organized sports provides an opportunity for young people to increase their physical activity and develop physical and social skills. However, when the demands and expectations of organized sports exceed the maturation and readiness of the participant, the positive aspects of participation can be negated. The nature of parental or adult involvement can also influence the degree to which participation in organized sports is a positive experience for preadolescents. This updates a previous policy statement on athletics for preadolescents and incorporates guidelines for sports participation for preschool children. Recommendations are offered on how pediatricians can help determine a child's readiness to participate, how risks can be minimized, and how child-oriented goals can be maximized.
Care of the Adolescent Sexual Assault Victim
Authors:   Committee on Adolescence
Published: August 2004

This Clinical Report was revised. See https://doi.org/10.1542/peds.2016-4243.
Sexual assault is a broad-based term that encompasses a wide range of sexual victimizations, including rape. Since the American Academy of Pediatrics published its last policy statement on this topic in 1994, additional information and data have emerged about sexual assault and rape in adolescents, the adolescent's perception of sexual assault, and the treatment and management of the adolescent who has been a victim of sexual assault. This new information mandates an updated knowledge base for pediatricians who care for adolescent patients. This statement provides that update, focusing on sexual assault and rape in the adolescent population.
Vocal Cord Paralysis Secondary to Impacted Esophageal Foreign Bodies in Young Children
Authors: Virgilis Dov , Weinberger Jeffrey M. , Fisher Drora , Goldberg Shmuel , Picard Elie , Kerem Eitan 
Published: August 2004

Impacted foreign bodies in the esophagus can result in respiratory symptoms including stridor and aphonia. Several mechanisms have been proposed to explain these symptoms, but the possibility of vocal cord paralysis and its cause has not been adequately emphasized.Two cases of young children with esophageal foreign body are described; both presented with respiratory symptoms, 1 with aphonia and the other with stridor. In both cases, the symptoms were secondary to vocal cord paralysis. A possible mechanism of recurrent nerve injury is proposed.
Tunneled Femoral Central Venous Catheters in Children With Cancer
Authors: Sovinz Petra , Urban Christian , Lackner Herwig , Kerbl Reinhold , Schwinger Wolfgang , Dornbusch Hansjürgen 
Published: August 2004

Objective.
We discuss the feasibility of long-term femoral venous access by means of a cuffed subcutaneously tunneled central venous catheter (Broviac catheter) in selected pediatric cancer and stem cell transplant patients in whom access via the veins of the upper part of the torso is difficult or contraindicated and in whom alternative routes must be used.

Patients and Methods.
We report on our experience with 9 patients (3 of whom underwent stem cell transplantation) who received femoral Broviac catheters between December 1990 and November 1999.

Results.
Time in place ranged from 4 to 155 days with a median of 58 days (mean: 71.2 days). Three catheters had to be removed: 1 because of infection of the subcutaneous tunnel and 2 because of catheter obstruction. The remaining 6 catheters functioned well without problems as long as they were needed; 1 of them got accidentally dislodged while the patient was off treatment. No episodes of catheter-related septicemia, thrombosis, kinking, or drug extravasation were noted; there were no catheter-related infectious complications in the transplant patients.

Conclusions.
Our experience indicates that in those instances in which customary access to the superior vena cava is precluded, long-term venous access by way of the femoral vein is a feasible and safe alternative in children, even in the setting of stem cell transplantation.
Urine-Based Enzyme-Linked Immunosorbent Assay for the Detection of Helicobacter pylori Infection in Children
Authors: Kato Seiichi , Tachikawa Tetsuya , Ozawa Kyoko , Konno Mutsuko , Okuda Masumi , Fujisawa Takuji , Nakazato Yutaka , Tajiri Hitoshi , Iinuma Kazuie 
Published: August 2004

Objective.
Serology and13C-urea breath test have been widely used as noninvasive tests to detect Helicobacter pylori infection. However, easier collection of samples and lower costs are desirable for diagnosis of the individual patient or for use in epidemiologic studies. Our aim was to study the diagnostic accuracy of a recently developed urine-based enzyme-linked immunosorbent assay (ELISA) kit for the detection of H pylori-specific immunoglobulin G (IgG) antibodies in children.

Study Design.
Specimens of serum and randomly voided urine were collected from 816 children (0–15 years old) and were analyzed using 2 serum-based ELISA kits and a urine-based ELISA kit, respectively. Based on results of serology, the sensitivity, specificity, and accuracy of the urine-based ELISA kit were evaluated. With regard to false-positive and false-negative results, urinary IgG concentrations and IgG/creatinine levels were studied.

Results.
Both serum-based ELISAs were positive in 41 children and were negative in 666, who were enrolled in this study. The remaining 109 children were excluded because of disagreement between the results of the 2 serum-based ELISAs, including indeterminate values. Overall sensitivity, specificity, and accuracy of urine-based ELISA test compared with serology were 85.4%, 95.5%, and 94.9%, respectively. On positivity rates, the urine-based ELISA was closely coincident with the serum-based ELISA in each age group. There was no correlation between antibody levels detected by urine-based ELISA and each serum-based ELISA. Urinary IgG concentrations and IgG/creatinine levels were significantly higher in false-positives and were lower in false-negatives than in true-positives plus true-negatives for serology. Most of those with false-positive results had trace to moderate proteinuria.

Conclusions.
The urine-based ELISA is an alternative to serum-based ELISA for diagnosis of H pylori infection in children and should be suitable for large-scale epidemiologic studies concerning the organism. In children with proteinuria, results of the test should be interpreted with caution. It is possible that the urine-based ELISA method would be applicable to diagnosis of other infectious diseases.
Prenatal and Postnatal Flavor Learning by Human Infants
Authors: Mennella Julie A. , Jagnow Coren P. , Beauchamp Gary K. 
Published: August 2004

Background.
Flavors from the mother's diet during pregnancy are transmitted to amniotic fluid and swallowed by the fetus. Consequently, the types of food eaten by women during pregnancy and, hence, the flavor principles of their culture may be experienced by the infants before their first exposure to solid foods. Some of these same flavors will later be experienced by infants in breast milk, a liquid that, like amniotic fluid, comprises flavors that directly reflect the foods, spices, and beverages eaten by the mother. The present study tested the hypothesis that experience with a flavor in amniotic fluid or breast milk modifies the infants' acceptance and enjoyment of similarly flavored foods at weaning.

Methods.
Pregnant women who planned on breastfeeding their infants were randomly assigned to 1 of 3 groups. The women consumed either 300 mL of carrot juice or water for 4 days per week for 3 consecutive weeks during the last trimester of pregnancy and then again during the first 2 months of lactation. The mothers in 1 group drank carrot juice during pregnancy and water during lactation; mothers in a second group drank water during pregnancy and carrot juice during lactation, whereas those in the control group drank water during both pregnancy and lactation. Approximately 4 weeks after the mothers began complementing their infants' diet with cereal and before the infants had ever been fed foods or juices containing the flavor of carrots, the infants were videotaped as they fed, in counterbalanced order, cereal prepared with water during 1 test session and cereal prepared with carrot juice during another. Immediately after each session, the mothers rated their infants' enjoyment of the food on a 9-point scale.

Results.
The results demonstrated that the infants who had exposure to the flavor of carrots in either amniotic fluid or breast milk behaved differently in response to that flavor in a food base than did nonexposed control infants. Specifically, previously exposed infants exhibited fewer negative facial expressions while feeding the carrot-flavored cereal compared with the plain cereal, whereas control infants whose mothers drank water during pregnancy and lactation exhibited no such difference. Moreover, those infants who were exposed to carrots prenatally were perceived by their mothers as enjoying the carrot-flavored cereal more compared with the plain cereal. Although these same tendencies were observed for the amount of cereal consumed and the length of the feeds, these findings were not statistically significant.

Conclusions.
Prenatal and early postnatal exposure to a flavor enhanced the infants' enjoyment of that flavor in solid foods during weaning. These very early flavor experiences may provide the foundation for cultural and ethnic differences in cuisine.
Autopsy Pathology of Pediatric Posttransplant Lymphoproliferative Disorder
Authors: Collins Margaret H. , Montone Kathleen T. , Leahey Ann M. , Hodinka Richard L. , Salhany Kevin E. , Belchis Deborah A. , Tomaszewski John E. 
Published: August 2004

Objectives.
Posttransplant lymphoproliferative disorder (PTLD) causes significant morbidity and mortality, is related to Epstein-Barr virus (EBV) infection, and is more common in children than in adults. We reviewed autopsies of children who died with PTLD to compare postmortem with antemortem PTLD histology, to assess the extent of PTLD, to document associated pathology, and to identify cause of death.

Methods.
Postmortem examinations were performed on 7 patients after bone marrow (n = 3) or liver (n= 4) transplant. PTLD was classified histologically as hyperplasia or lymphoma. In situ hybridization for EBER1 messenger RNA was performed on tissue samples from all cases. EBV serologies were used to categorize infections as negative, primary, or reactive.

Results.
PTLD was diagnosed in 5 children 12 to 35 (mean: 22) days before death, and 1.5 to 4 (mean: 3) months after transplant; PTLD was diagnosed in 2 cases at autopsy 2.5 and 4 months after transplant. Postmortem PTLD histology resembled antemortem histology; 5 PTLDs were lymphoma, 1 was hyperplasia, and 1 contained both lymphoma and hyperplasia. EBER1 messenger RNA was detected in 6 B-cell PTLDs, including lesions from patients who did not have EBV serology that indicated active infection. Complete autopsy of 4 patients who died with biopsy-proven PTLD revealed widely disseminated disease, and lymph node, brain, gastrointestinal tract, and kidney were involved in all 4 patients. Cases diagnosed at autopsy were 1 widely disseminated PTLD that had been suspected but not proven antemortem, and 1 PTLD confined to abdominal lymph nodes that was not suspected antemortem. Severe organ dysfunction (renal failure, gastrointestinal hemorrhage) was caused by massive PTLD infiltration in 2 patients. The conditions other than PTLD that contributed to morbidity and death were organ infection (5 cases), infarcts (4 cases), and diffuse alveolar damage (3 cases).

Conclusions.
PTLD may occur within weeks after transplant in children. The distribution of PTLD comprises a spectrum from localized and subclinical to widely disseminated and symptomatic. PTLD may cause demise quickly after the onset of signs and symptoms, through massive organ infiltration or associated conditions, such as diffuse alveolar damage. EBV serology may not accurately reflect the presence or extent of PTLD. Autopsy studies of transplant patients are necessary to identify the true incidence, natural history, and response to treatment of PTLD.
Impact of Breast Pumping on Lactogenesis Stage II After Cesarean Delivery: A Randomized Clinical Trial
Authors: Chapman Donna J. , Young Sara , Ferris Ann M. , Pérez-Escamilla Rafael 
Published: August 2004

Objective.Women at risk for delayed onset of lactation are often advised to pump their breasts before lactogenesis stage II to hasten the timing of this process. The effectiveness of this clinical practice has not been previously evaluated. This study investigates the effects of breast pumping before the onset of lactation on early milk transfer and subsequent breastfeeding duration among women giving birth by cesarean delivery.Methodology.Sixty women were randomly assigned to either the pumping group (n = 30), which used a double electric breast pump for six 10- to 15-minute sessions from 24 to 72 hours postpartum, or to the control group (n = 30), which held the pump to their breasts without suction for the same amount of time. Milk transfer was assessed by test weighing infants before and after 3 breastfeeding sessions daily. Test weight data were fitted to a second-order polynomial curve, to predict milk transfer over time.Results.Breast pumping between 24 and 72 hours after cesarean delivery did not improve milk transfer. Participants in the pumping group tended to have lower milk transfer than did controls. Primiparae in the pumping group breastfed for ∼5 months less than their counterparts in the control group; however, this difference was not statistically significant.Conclusions.Breast pumping did not improve milk transfer during the first 72 hours postpartum and may negatively affect breastfeeding duration among primiparous women. lactation, lactogenesis, breast milk, breast pumping, milk expression, breastfeeding, cesarean delivery.