bluuebunny/crossref_metadata_2025_split huggingface dataset:
Twelve-Month Safety and Efficacy of Inhaled Fluticasone Propionate in Children Aged 1 to 3 Years With Recurrent Wheezing
Authors: Bisgaard Hans , Allen David , Milanowski Janusz , Kalev Ilia , Willits Lisa , Davies Patricia 
Published: August 2004

Objective. Our aim was to compare the 12-month safety and efficacy of fluticasone propionate (FP) and sodium cromoglycate (SCG) in children aged 1 to 3 years with mild to moderate recurrent wheeze.Methods. The study was a randomized, parallel-group, open-label multicenter study of 625 children, aged 1 to 3 years, with recurrent wheeze randomized in a 3:1 ratio to treatment for 52 weeks with FP (100 μg twice daily) via metered-dose inhaler and Babyhaler spacer device or SCG (5 mg 4 times daily) via metered-dose inhaler and Nebuhaler spacer device, respectively.Results. There was no significant difference in mean adjusted growth rates between the 2 groups: 84.0 mm/year in the FP group versus 86.4 mm/year in the SCG group (difference FP-SCG: −2.4 mm/year; 95% confidence interval: −6.6 to 1.8). Growth comparisons were independent of age, gender, previous use of steroid, or whether measured as length and/or height. Serum and urinary cortisol concentrations showed a statistically significant suppression of 10% and 14%, respectively, but the number of patients with serum cortisol levels below the lower normal limit was reduced during the trial. Both treatments were well tolerated. The most common drug-related adverse events were cough (2% FP vs 1% SCG) and hoarseness (1% FP vs 0% SCG). One incident of cataract was observed at baseline and 1 after FP treatment; the latter had resolved after 12 months. The efficacy of FP was superior to SCG with fewer cases of symptom worsening, exacerbations, and requirements for oral steroid treatment and more symptom-free days and days without use of rescue treatment.Conclusions. Twelve months of treatment with inhaled FP (100 μg twice daily) in preschool children aged 1 to 3 years with recurrent wheeze has no effect on growth and no other clinically important side effects but is more efficacious than SCG.
Cost-Utility Analysis of Orthoptic Screening in Kindergarten: A Markov Model Based on Data From Germany
Authors: König Hans-Helmut , Barry Jean-Cyriaque 
Published: August 2004

Objective. To estimate the long-term cost-effectiveness of a hypothetical screening program for untreated amblyopia in 3-year-old children conducted by orthoptists in all German kindergartens in the year 2000.Methods. A cost-utility analysis was performed for which a decision tree was combined with a Markov model. Incremental costs and effects during the children’s remaining lifetime were estimated. The model took into account the probability of treatment without screening, age-specific treatment success rates, costs of screening and treatment, as well as effects of unilateral and bilateral visual impairment caused by amblyopia and other eye diseases coming along later in life on quality of life (utility). Model parameter values were obtained from a field study of orthoptic screening in kindergarten, from the literature, and from expert interviews. Costs were estimated from a third-party payer perspective. Uncertainty was assessed by univariate and probabilistic sensitivity analysis (Monte Carlo simulation).Results. The incremental cost-effectiveness ratio (ICER) of orthoptic screening was 7397 Euro (€) per quality-adjusted life year (QALY) when costs and effects were discounted at 5%. In univariate sensitivity analysis, the ICER was sensitive to the uncertainty regarding the utility of unilateral visual impairment and to the discount rate for effects; besides uncertainty regarding the prevalence of untreated amblyopia, the odds ratio of success of treatment when started late, and the probability of treatment without screening had a noticeable but much smaller effect. Monte Carlo simulation yielded a 90% uncertainty interval for the ICER of 3452 €/QALY to 72 637 €/QALY; the probability of an ICER &lt;25 000 €/QALY was 84%.Conclusions. The ICER of orthoptic screening seems to fall within a range that warrants careful consideration by decision-makers. Much of the uncertainty in results comes from the uncertainty regarding the effect of amblyopia on quality of life. To reduce this uncertainty, the impact of amblyopia on utility should be investigated.
The General Pediatrician: Projecting Future Workforce Supply and Requirements
Authors: Shipman Scott A. , Lurie Jon D. , Goodman David C. 
Published: August 2004

Objective. Trends affecting both the supply and requirements of child health physicians call into question earlier assessments about the adequacy of the general pediatric workforce. To understand the effects of these trends over time, we developed a model that projects the national supply of practicing general pediatricians over a 20-year period (2000–2020).
Design. The model incorporates current data on the practicing pediatrician workforce in the United States, pediatric residency graduates entering general pediatrics, and gender- and age-specific measures of productivity and of retirement or death. In addition, it accounts for projected changes in the size and ethnicity of the child population and the proportion of children currently receiving outpatient care from family practitioners.
Main Outcome Measures. Time trend of the supply of general pediatricians and the number of children in the population per practicing pediatrician.
Results. The baseline model projects that the number of general pediatricians will expand by nearly 25 000 by the year 2020, a 64% increase from the year 2000, whereas the child population is projected to expand by only 9%. The increase was robust to sensitivity analyses measuring the impact of each of the model’s variables on the future supply of pediatricians. In all probable scenarios, the general pediatrician workforce will expand significantly more rapidly than the child population. In addition, the trend in pediatrics is in marked contrast to the other primary care specialties.
Conclusions. Despite a number of factors that might attenuate the growth of the general pediatrician workforce, none seems sufficient to slow its expansion in relation to the pediatric population. To maintain practice volumes comparable to today, pediatricians of the future may need to provide expanded services to the children currently under their care, expand their patient population to include young adults, and/or compete for a greater share of children currently cared for by nonpediatricians.
Decrease of Invasive Pneumococcal Infections in Children Among 8 Children’s Hospitals in the United States After the Introduction of the 7-Valent Pneumococcal Conjugate Vaccine
Authors: Kaplan Sheldon L. , Mason Edward O , Wald Ellen R. , Schutze Gordon E. , Bradley John S. , Tan Tina Q. , Hoffman Jill A. , Givner Laurence B. , Yogev Ram , Barson William J. 
Published: August 2004

Objective. To monitor clinical and microbiologic features including antimicrobial susceptibility and serogroup distribution of invasive infections caused by Streptococcus pneumoniae among children before and after the introduction of routine administration of the 7-valent pneumococcal conjugate vaccine (PCV7).
Design. A 9-year (January 1, 1994 through December 31, 2002) prospective surveillance study of all invasive pneumococcal infections in children.
Patients. Infants and children cared for at 8 children’s hospitals in the United States with culture-proven invasive infections caused by S pneumoniae.
Results. When compared with the mean of the years 1994 to 2000, the annual number of invasive pneumococcal infections for children ≤24 months of age declined 58% in 2001 and 66% in 2002. If only the serogroups in the PCV7 are considered, the number of cases in children ≤24 months old declined 63% and 77% in 2001 and 2002, respectively. The greatest decrease was observed for serogroup-14 isolates. The number of isolates in nonvaccine serogroups increased 28% in 2001 and 66% in 2002 for children ≤24 months old. Nonvaccine serogroup-15 and -33 isolates had the greatest increase in number. The proportion of all isolates nonsusceptible to penicillin increased yearly from 1994 to 2000, reached a plateau in 2001 at 45%, and declined to 33% in 2002. Decrease in nonsusceptibility to penicillin occurred entirely in the isolates with penicillin minimum inhibitory concentration ≥2 μg/mL. Nonsusceptibility to penicillin increased slightly among nonvaccine-serotype isolates. Most infections after at least 2 doses of PCV7 were caused by nonvaccine-serotype isolates.
Conclusions. Since the introduction of the PCV7, the number of invasive pneumococcal infections caused by vaccine-serogroup isolates among 8 US children’s hospitals has decreased &gt;75% among children ≤24 months old. In addition, penicillin resistance decreased in 2002 for the first time since our surveillance began in 1993–1994. However, we have noted that replacement may be developing with serogroups 15 and 33. Furthermore, penicillin resistance seems to be increasing among nonvaccine serogroups. Surveillance must be continued to detect the emergence of changes in the distribution of serotypes as well as antibiotic susceptibility.
The Effect of Point-of-Care Personal Digital Assistant Use on Resident Documentation Discrepancies
Authors: Carroll Aaron E. , Tarczy-Hornoch Peter , O’Reilly Eamon , Christakis Dimitri A. 
Published: August 2004

Background. We recently found documentation discrepancies in 60% of resident daily-progress notes with respect to patient weight, medications, or vascular lines. To what extent information systems can decrease such discrepancies is unknown.
Objective. To determine whether a point-of-care personal digital assistant (PDA)-based patient record and charting system could reduce the number of resident progress-note documentation discrepancies in a neonatal intensive care unit (NICU).
Design/Methods. We conducted a before-and-after trial in an academic NICU. Our intervention was a PDA-based patient record and charting system used by all NICU resident physicians over the study period. We analyzed all resident daily-progress notes from 40 randomly selected days over 4 months in both the baseline and intervention periods. Using predefined reference standards, we determined the accuracy of recorded information for patient weights, medications, and vascular lines. Logistic and Poisson regression were used in analyses to control for potential confounding factors.
Results. A total of 339 progress notes in the baseline period and 432 progress notes in the intervention period were reviewed. When controlling for covariates in the regression, there were significantly fewer documentation discrepancies of patient weights in notes written by using the PDA system (14.4%–4.4% of notes; odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.15–0.56). When using the PDA system, there were no significant changes in the numbers of notes with documentation discrepancies of medications (27.7%–17.1% of notes; OR: 0.63; 95% CI: 0.35–1.13) or vascular lines (33.6%–36.1% of notes; OR: 1.11; 95% CI: 0.66–1.87).
Conclusions. The use of our PDA-based point-of-care patient record and charting system showed a modest benefit in reducing the number of documentation discrepancies in resident daily-progress notes. Further study of PDAs in information systems is warranted before they are widely adopted.
Chickenpox Outbreak in a Highly Vaccinated School Population
Authors: Tugwell Barna D. , Lee Lore E. , Gillette Hilary , Lorber Eileen M. , Hedberg Katrina , Cieslak Paul R. 
Published: August 2004

Objective. We investigated a chickenpox outbreak that started in an Oregon elementary school in October 2001, after public schools began phasing in a varicella vaccination requirement for enrollment. We sought to determine the rate of varicella vaccination and effectiveness and risk factors for breakthrough disease.Methods. A chickenpox case was defined as an acute maculopapulovesicular rash without other explanation occurring from October 30, 2001 through January 27, 2002 in a student without a prior history of chickenpox. We reviewed varicella vaccination records and history of prior chickenpox, and we calculated vaccine effectiveness. We evaluated the effects of age, gender, age at vaccination, and time since vaccination on risk of breakthrough disease (ie, chickenpox occurring &gt;42 days after vaccination).Results. Of 422 students, 218 (52%) had no prior chickenpox. Of these, 211 (97%) had been vaccinated before the outbreak. Twenty-one cases occurred in 9 of 16 classrooms. In these 9 classrooms, 18 of 152 (12%) vaccinated students developed chickenpox, compared with 3 of 7 (43%) unvaccinated students. Vaccine effectiveness was 72% (95% confidence interval: 3%–87%). Students vaccinated &gt;5 years before the outbreak were 6.7 times (95% confidence interval: 2.2–22.9) as likely to develop breakthrough disease as those vaccinated ≤5 years before the outbreak (15 of 65 [23%] vs 3 of 87 [3%]).Conclusions. A chickenpox outbreak occurred in a school in which 97% of students without a prior history of chickenpox were vaccinated. Students vaccinated &gt;5 years before the outbreak were at risk for breakthrough disease. Booster vaccination may deserve additional consideration.
Perinatal Predictors of Atopic Dermatitis Occurring in the First Six Months of Life
Authors: Moore Megan M. , Rifas-Shiman Sheryl L. , Rich-Edwards Janet W. , Kleinman Ken P. , Camargo Carlos A. , Gold Diane R. , Weiss Scott T. , Gillman Matthew W. 
Published: August 2004

Objective. Previous studies of predictors of atopic dermatitis have had limited sample size, small numbers of variables, or retrospective data collection. The purpose of this prospective study was to investigate several perinatal predictors of atopic dermatitis occurring in the first 6 months of life.Design. We report findings from 1005 mothers and their infants participating in Project Viva, a US cohort study of pregnant women and their offspring. The main outcome measure was maternal report of a provider’s diagnosis of eczema or atopic dermatitis in the first 6 months of life. We used multiple logistic regression models to assess the associations between several simultaneous predictors and incidence of atopic dermatitis.Results. Cumulative incidence of atopic dermatitis in the first 6 months of life was 17.1%. Compared with infants born to white mothers, the adjusted odds ratio (OR) for risk of atopic dermatitis among infants born to black mothers was 2.41 (95% confidence interval [CI]: 1.47, 3.94) and was 2.58 among infants born to Asian mothers (95% CI: 1.27, 5.24). Male infants had an OR of 1.76 (95% CI: 1.24, 2.51). Increased gestational age at birth was a predictor (OR: 1.14; 95% CI: 1.02, 1.27, for each 1-week increment), but birth weight for gestational age was not. Infants born to mothers with a history of eczema had an OR of 2.67 (95% CI: 1.74, 4.10); paternal history of eczema also was predictive, although maternal atopic history was more predictive than paternal history. Several other perinatal, social, feeding, and environmental variables were not related to risk of atopic dermatitis.Conclusions. Black and Asian race/ethnicity, male gender, higher gestational age at birth, and family history of atopy, particularly maternal history of eczema, were associated with increased risk of atopic dermatitis in the first 6 months of life. These findings suggest that genetic and pre- and perinatal influences are important in the early presentation of this condition.
Overweight, Ethnicity, and the Prevalence of Hypertension in School-Aged Children
Authors: Sorof Jonathan M. , Lai Dejian , Turner Jennifer , Poffenbarger Tim , Portman Ronald J. 
Published: August 2004

Objectives. To describe the current prevalence of pediatric hypertension and the relationships between gender, ethnicity, overweight, and blood pressure.
Methods. School-based screening was performed in 5102 children (13.5 ± 1.7 years) from May through November 2002. Age, gender, ethnicity, weight, and height were ascertained, and body mass index (BMI) was calculated as weight (kg)/height (m2). Overweight was defined as BMI ≥95th percentile. Students with blood pressure &gt;95th percentile on the first screening underwent a second screening 1 to 2 weeks later, and then a third screening if blood pressure was &gt;95th percentile at the second screening.
Results. Ethnicity distribution was 44% white, 25% Hispanic, 22% African American, and 7% Asian. Overall, overweight prevalence was 20%, which varied significantly by ethnicity (31% Hispanic, 20% African American, 15% white, and 11% Asian). The prevalence of elevated blood pressure after first, second, and third screenings was 19.4%, 9.5%, and 4.5%, respectively. Elevated blood pressure on first screening was highest among Hispanics (25%) and lowest among Asians (14%). Ethnic differences in the prevalence of hypertension (elevated blood pressure on 3 screenings) were not significant after controlling for overweight. The prevalence of hypertension increased progressively as the BMI percentile increased from ≤5th percentile (2%) to ≥95th percentile (11%). After adjustment for gender, ethnicity, overweight, and age, the relative risk of hypertension was significant for gender (relative risk: 1.50; confidence interval: 1.15, 1.95) and overweight (relative risk: 3.26; confidence interval: 2.50, 4.24).
Conclusions. These results confirm an evolving epidemic of cardiovascular risk in youth, as evidenced by an increase in the prevalence of overweight and hypertension, notably among ethnic minority children.
The Effects of Access to Pediatric Care and Insurance Coverage on Emergency Department Utilization
Authors: Johnson William G. , Rimsza Mary E. 
Published: August 2004

Objective. To compare children who used the emergency department (ED) in a rural, border community with those who did not over a 1-year period to estimate the effects of access to pediatric care, insurance coverage, ethnicity, gender, age, and area of residence on ED utilization.Design. Multivariate logit models are used to estimate the independent influence of demographic characteristics, insurance coverage, and access to pediatric care on ED utilization during 1999 by children 0 to 19 years of age.Results. Controlling for age, gender, ethnicity, and area of residence, children who received care from a private practice pediatric group were 73% less likely to utilize the ED if insured and 93% less likely if uninsured to use the ED than children who had not visited a pediatrician. Uninsured children were nearly 4 times more likely to use the ED than insured children. Among insured children, those covered by Medicaid were 54% less likely to use the ED than children with private insurance. Compared with white, non-Hispanic children, Asian or Hispanic children were no more likely to use the ED. Insured Native American children were more than twice as likely as white, non-Hispanic children to utilize the ED.Conclusions. Access to pediatric care is associated with a marked decrease in ED utilization regardless of insurance status. This decrease in ED utilization is especially large for uninsured children.
Developmental and Behavioral Status of Infants and Young Children Awaiting Heart or Heart-Lung Transplantation
Authors: Wray Jo , Radley-Smith Rosemary 
Published: August 2004

Objective. Research into cognitive development and behavior in children undergoing heart or heart-lung transplantation has focused mainly on older children, with investigation of children undergoing transplantation as infants or toddlers being largely retrospective. This study was conducted, therefore, to obtain pretransplant baseline measures of development and behavior for preschool-aged children.Methods. Children &lt;3.5 years old were assessed before transplantation (n = 35) and compared with a group of children awaiting conventional cardiac surgery, a group undergoing bone marrow transplantation, and a group of healthy children. Development was measured by using the Ruth Griffiths Mental Development Scales, and behavior was measured with the Achenbach Child Behavior Checklist.Results. Within the transplant group, 17 had congenital heart disease (CHD), and 18 had cardiomyopathy (CM). Although the overall mean developmental scores were within the normal range for the transplant, conventional cardiac surgery, and bone marrow transplantation groups, scores were significantly lower than those of the healthy group. Within the transplant group, those with CHD had a significantly lower mean developmental quotient than those with CM. Furthermore, the CHD patients obtained significantly lower scores than those with CM on areas of development covering locomotor abilities, speech and hearing, eye-hand coordination, and performance.Conclusions. In common with other groups of ill children, patients awaiting heart or heart-lung transplantation are at risk for developmental delay. Diagnosis is a salient factor in determining outcome in most areas of development. Psychosocial interventions need to be targeted to maximize developmental potential before transplantation.
Variations in Asthma Care by Race/Ethnicity Among Children Enrolled in a State Medicaid Program
Authors: Shields Alexandra E. , Comstock Catherine , Weiss Kevin B. 
Published: August 2004

Objective. To examine differences in the process of care for Medicaid-enrolled white, Hispanic, and black children with asthma.Design. Retrospective cohort study using Medicaid claims data to analyze the process of asthma care in 1994, including all white (non-Hispanic), black (non-Hispanic), and Hispanic children (aged 2–18 years) with asthma in the non-health maintenance organization portion of the Massachusetts Medicaid program (N = 5773). Main outcome measures included performance on 6 claims-based process-of-care measures that reflect national guidelines. Measures addressed primary and specialty care for asthma, appropriate asthma pharmacotherapy, and timely follow-up care after asthma emergency department (ED) visits and hospitalizations.Results. Controlling for case mix, provider type, disability status, age, and gender, Hispanic children with asthma were 39% less likely than white children to have a specialist visit for asthma (odds ratio [OR]: 0.61; confidence interval [CI]: 0.46–0.81) and 41% less likely to receive a follow-up visit within 5 days of being seen in the ED for asthma (OR: 0.59; CI: 0.36–0.95). However, Hispanic children received better care in 2 respects. They were 16% more likely than white children to receive a minimum of 2 asthma visits per year (CI: 1.01–1.34) and 27% less likely to be overprescribed β-agonist medications (OR: 0.73; CI: 0.54–0.99). Black children were 64% less likely than white children to receive timely follow-up care after being seen in the ED for asthma (OR: 0.36; CI: 0.18–0.73). There were no racial/ethnic differences in the prescribing of antiinflammatory medications or timely follow-up care after an asthma hospitalization.Conclusions. This study demonstrates important differences in the process of care experienced by racial/ethnic subpopulations within a Medicaid population, which may help explain differential outcomes. Efforts to improve asthma outcomes should target specific areas in which black and Hispanic children may be receiving suboptimal care.